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Bental  Btgejeit 


TABLE  OF  CONTENTS 

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GENERAL  INDEX  FOR  VOL  XXll. 

JANUARY-DECEMBER,  1916 


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EDITED  BY 

GEORGE  WCK)D  CLAPP.  D.  D.  S. 

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THE  DENTISTS'  SUPPLY  COMPANY 

CANDLER  BUILDING 

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TABLE  OF  CONTENTS,   1916 
VOLUME  xxn 


ORIGINAL  CONTRIBUTIONS 

PAGE 

A  Detachable  Cusp  for  Steele V Facings..* ! M.  G.  Philups,  D.D.S.  763 

Accuracy  in  Amalgam  Restorations :  .W.  Go'ddard  Sherman,  D.D.S.  562 

Adjusting  Obturators J.  E.  Kurlander,  D.D.S.  and  H.  J.  Jaulusz,  D.D.S.  217 

American  Fair  Play 779 

An  April  Vacation \V.  B.  Lee,  D.D.S.  368 

An  Auto  Trip,  August,  1915 J.  M.  Miller,  D.D.S.  376 

An  Intermaxillaiy  Splint George  Morris  Dorrance,D.D.S.  645 

An  Outing  in  the  Ozarks B.  L.  Gamble,  D.D.S.  385 

Anatomical  Articulation,  A  Trip  Registering  the  Western  Attitude  Toward 

Dayton  Dunbar  Campbell,   D.D.S.  79 

Are  State  Dental  Laws  Reasonable?    Name  of  Author  Known  but  Withheld 710 

Banquet  to  Mr.  Thomas  Forsyth   781 

Better  Gold  Inlay,  A W.  Goddard  Sherman,  D.D.S.  149 

Bleaching  Technic  of  Natural  Tooth  in  the  Mouth Louis  Englander,  D.D.S.  215 

Cast  Cusp  Gold  Crown A.  Bruce  Coffin,  D.D.S.  293 

Closed  Mouth  Impressions Samuel  G.  Slt»plee,  4,  74,  139,  290,  413,  498,  567,  700,  764 

Closure  of  Jaw  in  Mastication Loomis  P.  Haskell,  D.D.S.  502 

Complete  Description  of  My  Most  Successful  Operation H.  M.  Demarest,  D.D.S.  627 

Conservative  and  Constructive  Treatment  of  Riggs'  Disease M.  H.  Cazier,  M.D.  775 

Correct  and  Incorrect  Cuspid  Relations  Russell  W.  Tench,  D.D.S.  561 

Cow  Bell  Method  of  Casting  Aluminum  Bases W.  Clyde  McClelland,  D.D.S.  416 

Cuspid  Relations,  Correct  and  Incorrect Russell  W.  Tench,  D.D.S.  561 

Delightful  Camping  Trip Walter  S.  Cole,  D.D.S.  370 

Delightful  Vacation  and  Some  Conclusions C.  W.  Weaver,  D.D.S.  362 

Dental  Hygienists Edward  F.  Brown,  D.D.S.  284 

Devitalization,  Shall  we  Discontinue    Walter  S.  Kyes,  D.D.S.  207 

Eighth  Annual  Hay  Fever  Pilgrimage T.  M.  Robertson,  D.D.S.  402 

Evolution  of  a  Prosthodontist Sinclair  Weeks,  D.D.S.  6 

Exodontia  Under  Nitrous  Oxide  and  Oxygen  Anesthesia,  Bertram  R.  Perkins,  D.D.S.  796 
Expansion  and  Contraction  in  Plaster  and  Vulcanite  Stewart  J.  Spence,  D.D.S.  491,  557 
Experiments  to  Determine  the  Toxicity  of  Therapeutic  Agents  in  the  Treatment  of 

Pyorrhea  on  Normal  Cells  Grown  m  Vitro W.  F.  Spies,  D.D.S.  69 

Fate  of  An  "  Innocent  Bystander" Floy  Tolbert  Barnard  345 

Fatigue,  Its  Cause,  Nature,  and  Cure Watson  W.  Eldridge,  M.D.  398 

Finishing  Process  of  Artificial  Dentures T.  G.  Healy,  D.D.S.  422 

Food  for  Dentists Watson  W.  Eldridge,  M.D.,    155,  276,  621 

Gold  Crown,  Cast  Cusp A.  Bruce  Coffin,  D.D.S.  293 

Gold  Crowns,  for  Posterior  Teeth,  Where  Bite  is  Very  Close,  Technic  for  Making 

Raymond  S.  Scovil,  D.D.S.  143 

Gold  Inlay,  A  Better W.  Goddard  Sherman,  D.D.S.  149 

Good  Time  in  Pocahontas  County,  W.  Va E.  W.  Hill,  D.D.S.  384 

Great  National  Movement,  A W.  G.  Ebersole,  M.D.,  D.D.S.  9 

Hunting  with  Airedale  Terriers A.  P.  Deacon,  D.D.S.  351 

Impacted  Third  Molar  Causes  Facial  Paralysis B.  Barrymore  Marco,  D.D.S.  566 

Important  Information  from  the  Dental  Protective  Association  of  the  United  States    .  85 

Impressions,  Closed  Mouth ....  Samuel  G.  Supplee,  4,  74,  139,  290,  413,  498,  567,  700,  764 

iii 


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iv  TABLE  OF  CONTENTS,  1916 

PAGE 

Jaws,  Fractured,  Treatment  of William  C.  Mogh,  D.D.S.  i 

Launch  Trip,  A L.  A.  Lupton,  D.D.S.  386 

Ludwig's  Angina Jno.  W.  Seybold,  D.D.S.  483 

My  Quest  for  Pike W.  S.  Walters,  D.D.S.  354 

Natural  Cleansing  of  the  Mouth  by  Natural  Means Bernard  Feldman,  D.D.S.  485 

N.  Y.  College  of  Dentistry,  Semi-centennial  Celebration 410 

Orthodontia  of  the  Deciduous  Teeth E.  A.  Bckue,  D.D.S.,  M.D.    631,  691,  757 

Our  Vacation  in  1915 J.  C.  Higgason,  D.D.S.  390 

Our  Wisconsin  River  Trip C.  F.  Stekl,  D.D.S.  374 

Out  in  the  Fields C.  R.  Christopher,  D.D.S.  393 

Perfect  Articulation  in  Posterior  Bridgework  by  the  Use  of  Trubyte  Molar  Blocks 

R.  D.  Pray,  D.D.S.  294 

Problem  of  Mouth  Washes Chas.  M.  MacKenzie,  D.M.D.  625 

Progressive  Prosthetic  Clinic H.  J.  Horner,  D.D.S.,  W.  J.  Holroyd,  D.D.S., 

C.  J.  McChesney,  D.D.S.  640 

Progressive  Prosthetic  Clinic.  ...H.  C.  Werts,  D.D.S.,  F.  A.  Gallagher,  D.D.S.    705,  707 
Pyorrhea,  Treatment  of,  Experiments  to  Determine  the  Toxicity  of  Therapeutic  Agents 

in  the W.  F.  Spies,  D.D.S.  69 

Rapid  and  Accurate  Method  of  Soldering  the  Pin  to  a  Richmond  Cap 

J.  M.  WooDLE,  D.D.S.  565 

Rationale  of  Riggs'  Disease Marion  Howard  Cazier,  M.D.  553 

Repairing  Carious  Teeth Harvey  Richmond,  D.D.S.  642 

Riggs'  Disease,  Rationale  of Marion  Howard  Cazier,  M.D.  553 

Rugae Victor  Lay,  D.D.S.  145 

Selection  of  Teeth N.  L.  Zimmerman,  D.D.S.  424 

Septic  Wheel  Brush,  The "R.  R.  C."  148 

Shall  we  Discontinue  Devitalization? Walter  S.  Kyes,  D.D.S.  207 

Shoulder  Crown  and  Its  Technic Francis  C.  Jones,  D.D.S.  643 

Something  Different Edward  T.  Brunson,  D.D.S.  364 

Specific  for  Poison  Oak  or  Ivy F.  L.  Dung.\n,  D.D.S.  365 

Splint,  an  Intermaxillary George  Morris  Dorrance,  D.D.S.  645 

Successful  Deer  Hunt  in  Massachusetts Charles  L.  Twichell,  D.D.S.  380 

Sugar  and  Its  Effect  Upon  the  Teeth John  S.  Engs,  D.D.S.     146,  212 

Sure  Cure  and  a  Pleasant  One L.  P.  Larson,  D.D.S.  381 

Technic  of  Natural  Tooth  Bleaching  in  the  Mouth Louis  Englander,  D.D.S.  215 

Technic  for  Making  Gold  Crowns  for  Posterior  Teeth  in  Mouth  WTiere  the  Bite  is 

Very  Close Raymond  S.  Scovil,  D.D.S.  143 

The  Beach  or  Mountains? L.  M.  Zimmerman,  D.D.S.  372 

The  Dentist,  The  Patient  and  Oral  Prophylaxis Joseph  H.  Kauffmann,  D.D.S.  760 

The  First  Night  in  the  Woods Paul  S.  Coleman,  D.D.S.  360 

Things  That  are  Said  in  Dental  Journals Hillel  Feldman,  D.D.S.  219 

To  Separate  Gold  from  Platinum S.  M.  Myers,  D.D.S.  427 

Treatment  of  Fractured  Jaws William  C.  Mogh,  D.D.S.  i 

Trip  Registering  the  Western  Attitude  to  Anatomical  Articulation 

Dayton  Dunbar  Campbell,  D.D.S.  79 

Up  the  Oswegatchie  After  Trout H.  O.  Brown,  D.D.S.  405 

Valuable  Suggestions  in  Training  Assistants Reported  by  J.  E.  Waterbury,  D.D.S.  495 

Value  of  Oysters 708 

Week  at  Lake  Geneva,  Wis Elberg  N.  Johnson,  D.D.S.  359 

What  a  Vacation  Did  for  Me J.  H.  Bltins,  D.D.S.  366 

What  I  Like  About  My  Dentist "CD.  B."  18 

Why  a  Vacation  and  Where J.  A.  McPhail,  D.D.S.  394 

Why  Discard  the  Tooth  Brush? Ernest  C.  Dye,  A.B.,  D.D.S.  280 


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TABLE  OF  CONTENTS,  1916 
BUSINESS  BUILDING  ARTICLES 


Advice  to  Those  About  to  Wear  Artificial  Teeth 249 

Agreement  to  Surrender  Practice Arthur  L.  H.  Street  510 

Always  Render  Your  Best  Service 451 

Answer  to  a  Request  for  Advice 235 

Answers  to  "B.  C.  G."   794,  795 

Around  the  Table   790 

Brother  Bill's  Letter 33 

Business  Side  of  Dentistr\' 239 

Business  Side  of  Prophylactic  and  Restorative  Practice 

\V.  F.  Spies,  D.D.S.,  and  George  Wood  Clapp,  D.D.S.     19,  94,  435 

Can  He  Prove  It? 453 

Canadian  Dental  Association 709 

Commercialism  and  Dentistry Frank  L.  Platt,  D.D.S.  577 

Codperation 658, 659 

Costs  of  Conducting  Dental  Practice L.  W.  D.  721 

Dentistry  from  a  Financial  .Vspect Pkrcy  A.  Ash,  D.D.S.     160,  165 

Dentists'  Office  Hours 241 

Dollars,  The  1914  and  1915 308, 309 

Employment  of  Unlicensed  Assistants .\rthitr  L.  Street  580 

Ethics  as  It  is  Lived J.  F.  Conover,  D.D.S.,  787 

Fees,  How  Can  You  Raise,  and  Keep  the  Good  Will  of  a  Community? 450 

Fees,  Professional I.  J.  Dresch  719 

Fifty-fifty W.  F.  DA\as,  D.D.S.  296 

Getting  the  Money 52 

How  Can  He  Better  Conditions? **E.  S.  G."  27 

How  to  Make  a  Dentist  Happy 238 

How  to  Make  and  Save  a  Competency  for  Old  Age *'N.  W.  D."  22 

"Josh,"  A  Reply  to,  in  March  Digest "R.  L.  S."  310 

"Josh"  Comes  Back 171 

Layman's  Viewpoint,  A Katharine  Dodge  648 

Living  Costs  and  Dental  Fees L.  W.  Dunham,  D.D.S.  574 

My  Way  of  Figuring  the  Cost  of  an  Inlay "C.  A.  G."  31 

Necessity  for  Keeping  Complete  Records C.  Charles  Clark,  D.D.S.  300 

Practical  Illustration  of  Success "C.  F."  D.D.S.  506 

Professional  Denture  Service — Professional  Denture  Fees L  J.  Dri-:sch  719 

Relation  of  the  Dentist  to  the  Manufacturer  and  Dealer Guy  Morgan,  D.D.S.  584 

Reply  to  M.  F.  R "H.  K,"  29 

Request  for  Advice iii 

Saving  for  the  Rainy  Day  and  Old  Age  Fund "  A.  H."  517 

Sellmg  Denture  Service I.  J.  Dresch  303 

Some  Thoughts  on  the  Business  Side  of  Practice D.  R.  Phelps,  D.D.S.  722 

State  of  Michigan,  Supreme  Court 725 

Successful  Practice  of  Dentistry Wallace  Secxombk,  D.D.S.    444,  5x1 

System  of  Dental  Book-keeping F.  Z.  Ros{>,  D.D.S.  103 

The  Whole  World  is  a  Big  Store 449 

What  do  you  Believe? L.  W.  Dunham,  D.D.  S.  793 

What  I  Think  Inlays  Cost "F.  D.  H."  98 

What  Shall  we  Charge  for  Plates? W.  J.  Holrovd,  D.D.S.  226 

Where  Have  my  Profits  Gone? Nils  Juell,  D.D.S.  308 

Who  is  Responsible  for  Low  Fees? C.  Wayne  Mingle,  D.D.S.  516 

Why  I  Think  it  Pays  to  be  Courteous "A.  B.  D."  5x4 


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▼i  TABLE  OF  CONTENTS,  1916 

PRACTICAL  HINTS 

PAGE 

A  Gasoline  Soldering  Outfit 245 

A  Good  Probe 108 

A  Good  Temporary  Filling 454 

A  Kink  Worth  Knowing  in  Mending  Rubber  Plates 5^3 

A  Laboratory  Hint 1 50 

A  Loose  Pin  Banded  Crown  Especially  Adapted  for  Upper  Lateral  Incisors 244 

A  Method  for  the  Correct  Application  of  Davis  Crown  to  Roots 114 

A  Method  of  Applying  Arsenical  Paste 38 

A  New  Method  of  Handling  Undercuts  in  Making  Metal  Plates 314 

A  One-Mix  Investment  for  Small  Repairs 307 

A  Painless  Way  to  Open  a  Sore  Tooth 113 

A  Porcelain  Jacket  Crown 177 

A  Time  Saving  Hint 99 

A  Useful  Application  for  Sore  Lips  While  Operating 244 

An  Ordinary  Hail  Screen 113 

Adapting  Upper  Dentures 732 

Aid  in  Soldering 292 

An  Abscess  Lancet 30 

An  Aid  in  Making  Large  Plumpers 145 

Burning  Out  Wax 454 

Dissolving  Impression  Plaster 295 

Extracting  a  Post  From  a  Frail  Root 40 

Facilities  for  Removing  Teeth  from  a  Rubber  Plate 99 

Following  the  Preparation  ©f  a  Bridge  Impression 589 

For  Quick  Devitalizing 731 

For  Cases  of  Gengivitis 799 

For  Sensitive  Root  Canal 313 

For  Sound  Teeth,  that  are  Sensitive  at  the  Neck 798 

Heater  for  Water  and  Spray  Bottles 732 

How  to  Remove  Broken  Instruments 245 

Hypodermic  Syringes 246 

Leaky  Vulcanizer 176 

Making  Mould  (in  Ring)  Stick  to  Casting  Machine  While  Casting 588 

Method  of  Holding  Inlay  for  Polishing 522 

Method  of  Separating  and  Regaining  Space  Where  Teeth  Have  Been  Lost  for  Some  Time  39 

Methods  of  Relieving  Pain  While  Operating ^i^ 

Methods  to  Facilitate  the  Attachment  of  Gold  Castings  to  Steele's  Backings 31a 

Mixing  Amalgam ^2, 

Nature's  Own  Anesthetic -j^ 

Plate  Quickly  Repaired ^-j 

Polishing  Crowns -j2 

Preventing  the  Cracking  and  Bleeding  of  Chapped  Lips ^  j . 

Removing  Steele's  Facings ^2 

Rendering  Cork  Stoppers  Impermeable 

Repairing  a  Broken  Goslee  Tooth 

Repairing  Plaster  Casts 

Repairing  Punctures  in  Rubber  Dam  after  Adjusting 

Removing  Broken  Broach  from  Root  Canal 

Root  Canal  Filling r^ 

Root  Canal  Filling  Material 

Ruga •••*•'*'' '*^*!'!;;^  ^  5^ 

Rugae  on  Plates . ^ 

^                                                                                176 


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TABLE  OF  CONTENTS,  1916  vH 

PAGE 

Securing  Brightness  in  Aluminum  Rubber  Plates 317 

Sq)arating  Modeling  Compound  Impressions 178 

Simple  Assortment  of  Casting  Rings 454 

Simple  Method  of  Altering  Seamless  Crown  Dies 313 

Simple  Procedure  in  Antrum  Operation 588 

Strengthening  Plaster  Models 178 

The  Correct  Method  for  Manipulating  Amalgam 731 

TTiree  Hints  That  I  Find  Practical 38 

To  Avoid  Bubbles  in  Casting 544 

To  Qean  a  Glass  Slab  of  Cement 176 

To  Do  Away  With  the  Very  Much  Complained  o^  Bellows  to  Splcicrin;5  Outfit 177 

To  Facilitate  Waxing  Parts  of  Broken  Vulcanite'Plates  ToiJelher ..'/... 177 

To  Finish  a  Silicate  Filllin^.  I . . .,   * .'..'**.*/. ' . . - ~. .  v-t^  .:•  .•;-752/ 

To  Flow  Solder  Easily :;:.J.VV  :.\.l<.\  . .  .\ '.^.i .:. .  ]  iff 

To  Get  Proper  Results  When  Uaag  Synthetic  Porcelain  in  Pra.ximal  Occlusal  Cavities 

in  Bicuspids  and  Molars •:*<•: 312 

To  Grind  Natural  Teeth  Painlessly '.....  .\  ^:  .^-: . .  177 

To  Make  a  Beautiful  Plate 314 

To  Make  a  Two  Piece  Shell  Crown  Serve  as  Bridge  Abutment 176 

To  Make  Over  an  Old  Bur 454 

To  Open  Hypodermic  Needle 798 

To  Prevent  Saliva  from  Getting  Into  the  Handpiece 522 

To  Prevent  the  Softening  of  Carving  Compound  in  Metal  Plates 314 

To  Prevent  Thumb-Sucking  in  Children 39 

To  Remove  an  Inlay  Model 114 

To  Remove  Richmond  Crown 522 

To  Repair  a  Hole  in  a  Bicuspid  or  Molar  Crown 113 

To  Repair  Gold  Crowns 245 

To  Replace  Pin  Facing  on  a  Bridge  Which  Has  Post  Abutments 588 

To  Restrict  the  Flow  of  Solder 178 

To  Save  Time  During  the  Use  of  Silicate  Cements 302 

To  Splice  an  Engine  Cable 312 

To  Stop  a  Leaky  Vulcanizer 176 

To  Stop  a  Leaking  Vulcanizer 454 

To  Tighten  Old  Plates 113 

Useful  Hints 178 

Use  for  Worn  Joe  Dandy  Stones  or  the  Knife  Edged  Stone  With  Hub  in  the  Centre 522 

Vaseline  an  Aid  in  Swaging  Shell  Crowns 720 

Water  and  Teeth 40 

WaxedSilk 108 

When  Glower  Bums  Out  in  the  Dentiscope  Lamp 1 14 

QUESTIONS  AND  ANSWERS  TO  PRACTICAL  HINTS 

41,  IIS,  "6, 179,  180,  246, 316, 455,  523,  733,  734,  799,  300,  301 

DIGESTS 

Artificial  Teeth,  Advice  to  Those  About  to  Wear D.  W.  Barker,  D.D.S.  249 

Conversation 182 

Codperation  Between  the  Dentist  and  the  Orthodontist 459 

Dental  Surgery 803 

Emetin  vs.  Surgery  in  the  Treatment  of  Pyorrhea    Thomas  N.  Hartzell,  D.D.S.,  M.D.  666 

Extragenital  Chancres 183 

Food  Consumption  of  Adolescent  Boys 802 

Gift  to  Dental  School 642 


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▼iii  TABLE  OF  CONTENTS,  1916 

PAGE 

High  Cost  of  Living 804 

Infection  of  the  Hands  and  Fingers  of  Physicians 183 

Management  of  Children  and  the  Treatment  of  Teeth 416 

Nature,  Manner  of  Conveyance  and  Means  of  Prevention  of  Infantile  Paralysis 

Simon  Flexner,  M.D.  591 

Oil  of  Turpentine  as  a  Haemostatic G.  Grey  Turner,  M.D.,  F.R.C.S.  182 

Partial  Dentures W.  E.  Cummer,  D.D.S.  526 

President  Butler  Appeals  for  $1,000,000  to  Endow  Columbia  Dental  School 458 

Preventive  Dentistry  and  the  Dental  Nurse Woods  Hutchinson,  M.D.  529 

Proposed  Statement  of  Aims  and  Objects -. 247 

Spare  the  Toothbrush ^jlbB'fiie^inlJj  .-^* :  •. . . : Woods  Hutchinson,  M.D.  527 

The  Blaster :  .  •*.;  .;:\  /  .V  •...:.:  ...•; i8a 

♦.  .*  •:• : «::  :*.:  "•  \  /  •  •::  •  aocrExf  «oVe&    ■ 

Alabim&  tTen\aI  Association .*^'  .  .*.* ^.^ , 203,  271 

American  In9d^^*v^IDBeA!41^eacher». . /^  .*2*  5*  i  ■  •^^  -•  •  ^ ^^»  ^^3 

Arizona  SoEiKl^r^ioial  Eikhuners.^I  .".'.**  .1 .  .^^  * . sh^.  . 271 

Arkansas  State  Board  Dental  Examiners 823 

Arkansas  State  Dental  Association 203, 339 

California  Board  of  Dental  Examiners 339,  823 

Colorado  State  Dental  Association 339 

Connecticut  State  Dental  Association 271 

District  of  Columbia,  Meeting  of  Examination  Board 67 

Florida  State  Dental  Society 203,  271, 340 

Georgia  State  Dental  Association 271, 340 

Idaho  State  Dental  Association 271 

Illinois  State  Dental  Society 203,  207, 340 

Indiana  State  Dental  Association 271, 340 

Iowa  State  Board  of  Dental  Examiners 823 

Iowa  State  Dental  Society 203,  271,  340 

Kentucky  State  Dental  Society 271, 340 

Lake  Erie  Dental  Association 203 

Louisiana  State  Dental  Society 273 

Maine  Dental  Society 340 

Mar>'land  State  Dental  Association 203 

Massachusetts  Dental  Society 203,  207 

Michigan  State  Board  of  Dental  Examiners 203,  207, 340 

Minnesota  State  Dental  Association 67,  823 

Mississippi  Dental  Association 203,  207 

Missouri  State  Board  of  Dental  Examiners 340 

Montana  State  Board  of  Dental  Examiners 341 ,  823 

National  Dental  Association 137,  287, 409, 480 

Nebraska  State  Dental  Society 203,  272, 341 

New  Jersey  State  Dental  Society 341 

New  York  College  of  Dentistry,  Semi-Centennial 410 

New  York  State  Dental  Society 203,  272, 341 

Northern  Ohio  Dental  Association 341 

North  Carolina  State  Board  of  Dental  Examiners 67, 823 

North  Dakota  State  Board  of  Dental  Examiners 67 

Odontological  Society  of  Western  Pennsylvania 204,  272 

Ohio  State  Dental  Association 823 

Pennsylvania  Board  of  Dental  Examiners 272, 341,  823 

Rhode  Island  State  Board  of  Registration 341 

Sixth  District  Dental  Society  of  New  York 203 


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GSNERAL  INDEX  FOR  1916 


South  Carolina  State  Dental  Association 204,  272 

South  Dakota  State  Board  of  Dental  Examiners 67, 823 

Tennessee  "Board  of  Dental  Examiners 34^ 

Texas  State  Dental  Association 204,  272, 341 

Tri-State  Post  Graduate  Dental  Meeting  (Missouri,  Kansas,  Oklahoma) 203 

Vermont  Board  of  Dental  Examiners 272, 342 

Washington  University  Dental  Alumni  Association 67 

West  Virginia  State  Dental  Association 204,  272 

Wisconsin  State  Board  of  Dental  Examiners 204,  272, 342 

Wisconsin  State  Dental  Society 67,  272 

EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  UTERATURE 

42-65, 117-136, 184-202,  251-270, 464-477,  534-553,  590, 607-618, 663-665, 672-688, 805-821 

MISCELLANEOUS 

Obituaries 66,  136,  336,  477 

Book  Reviews 66, 607, 689,  822 

Correspondence 

8, 92, 93,  "2, 174. 175,  241,  242, 31 1, 315, 531,  572, 641, 653,  654,  660,  661,  729,  730,  783,  784 
Future  Events 67, 137,  205,  273, 343, 410, 482,  552, 620, 690,  756 

INDEX  BY  MONTHS 

January 1-68  July 413-482 

February 69-138  August 483-552 

March 139-206  September 453-620 

April 207-274  October 621-690 

May 275-342  Nov-EicBER 691-756 

June 343-412  December 757-824 

GENERAL  INDEX  FOR  1916 
VOLUME  xxn 

A 

A  Biblical  Quotation 730 

A  Delightful  Camping  Trq) 370 

A  Delightful  Vacation  and  Some  Conclusions 362 

A  Good  Tunc  in  Pocahontas  County,  W.  Va 384 

A  Launch  Trip 386 

A  Specific  for  Poison  Oak  or  Ivy 365 

"A.  B.  D." 514 

A  Slam  or  an  Earnest  Proposition? 433 

Adams,  F.  L.,  D.D.S 311 

Advice  to  Those  About  to  Wear  Artificial  Teeth 249 

Agreement  to  Surrender  Practice 510 

"A.  H." 517 

Alaska  Dental  Society 453 

Alien,  Dr.  J 153 

Always  Render  Your  Best  Service 451 

Amalgam  Ktetorations,  Accuracy  in 562 

An  April  Vacation 368 

An  Internuuriliary  Splint 645 

An  Outing  In  the  Ozarks 385 

Answer  to  a  Query 243 

Answer  to  a  Request  for  Advice 235 

Answers  to  "M.  F.  R." 30,   31 


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X  GENERAL  INDEX  FOR  1916 

PACE 

Answers  to  " Perplexed" 434 

Angina,  Ludwig^s 483 

Are  State  Dental  Laws  Reasonable? 710 

Army  Dental  Corps,  New  Legislation  Affecting 481 

Around  the  Table 790 

Articulation,  Perfect,  in  Posterior  Bridgework  by  Use  of  Trubyte  Molar  Blocks 295 

Artificial  Dentures,  Finishing  Process  of 422 

Ash,  Percy  A^D.  D.S 100, 165 

Assistants,  Training,  Valuable  Suggestions  in 495 

Assistants,  Unlicensed  Employment  of 580 

Association  of  Commerce 463 

Avoid  Appetizers 28 

B 

"  B  " 452 

Bachelor,  O.  D 660 

B.  A.  G 794 

"B.  A.  J." 237 

Banquet  to  Mr.  Thomas  Forsyth 781 

Barker,  D.  W.,  D.D.S 249,  782 

Barnard,  Floy  Tolbert 345 

"B.  C.  G." 651 

Beach  or  Mountains? 372 

Bebyia,  F.  S.,  D.  M.  D 782 

Better  Doctoring  for  Less  Money 581 

Bogue,  E.  A.,  M.D.,  D.D.S 631, 691, 757 

Bookkeeping,  System  of  Dental 103 

"Boston" 112 

Braucher,  Olga  Thimme 533 

Brother  Bill's  Letter 33 

Brown,  Edward  F.,  D.D.S 284 

Brown,  H.  O.,  D.D.S 405 

Brunson,  Edward  T.,  D.D.S 364 

Buckley,  J.  P.,  D.D.S 89 

Bulletin  of  the  Association  of  Military  Dental  Surgeons 730 

Bums,  J.  H.,  D.D.S 366 

Business  Side  of  Dentistry 239 

Business  Side  of  Restorative  and  Prophylactic  Practice iQ*  94i  435 

C 

Cabot,  Richard  C,  M.D 581 

"  C.  A.  G." 31 

California  State  Dental  Association,  Bulletin  of  the 505 

Campbell,  Dayton  Dunbar,  D.D.S 79 

Can  He  Prove  It? 453 

Canadian  Dental  Association,  1916 709 

Caries — Repairing  Carious  Teeth 642 

Caution 311 

Cazier,  Marion  Howard,  M.D 553,  775 

"  C.  F." 506 

Chamberlain,  L.A.,  D.D.S 172 

Chancres,  Extragenital 183 

Change  of  Color 516 

Ch&teau  de  Passy 717 


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GSNERAL  INDEX  FOR  1916  zi 

PAGE 

Christopher,  C.  R.,  D.D.S 393 

Oapp,  Geoige  Wood,  D.D.S 19, 94,  i59, 435 

Clappison,  O.  S.,  D.D.S 601 

Clark,  C.  Charles,  D.D.S 300 

"Clinic,"  Meaning  of  the  Word 782 

Closed  Mouth  Impressions 4»  74,  i39,  290,  413,  498,  597,  700,  763 

Closure  of  Jaw  in  Mastication 502 

Clyde  Davis,  D.D.S 221 

Coffin,  A.  Bruce,  D.D.S 293 

Cole,  Walter  S.,  D.D.S 370 

Coleman,  Paul  S.,  D.D.S 360 

Columbia,  $125,000  for 795 

Columbia  Dental  School,  President  Butler  Appeals  for  $1 ,000,000  to  Endow 458 

Colyer,  J.F 494 

Commercialism  and  Dentistry 577 

Complete  Description  of  My  Most  Successful  Operation 627 

Conditional  Sale  of  Dental  Fixtures  and  Furniture 15 

Conovcr,  J.  F.,  D.D.S 787 

Conservative  and  Constructive  Treatment  of  Riggs*  Disease 775 

Conversation 182 

Cooperation 658, 659 

Cooperation  Between  the  Dentist  and  the  Orthodontist 459 

Correct  and  Incorrect  Cuspid  Relations 561 

Cost  of  an  Inlay,  My  Way  of  Figuring 31 

Costsof  Conducting  Dental  Practice 721 

Cotton  Brigade 520 

Court  Decision,  Appellate,  on  Some  Points  of  Interest  in  Dental  Laws  and  Their  En- 
forcement    460 

Cow-Bell  Method  of  Casting  Aluminum  Bases 416 

"  C.  S.  L." 1 74 

Cunmier,  W.  E.,  D.D.S 526 

D 

Davis,  W.F.,  D.D.S 296 

Deacon,  A.  P.,  D.D.S 351 

Deciduous  Teeth,  Orthodontia  of  the 631, 691,  757 

Dcmarest,  H.  M.,  D.D.S 627 

Dental  Economics 587 

Dental  Hygienists 284 

Dental  Laws,  Decision  in 460 

Dental  Nurse,  Preventive  Dentistry,  and  the 529 

Dental  Protective  Association,  Important  Information  from  the 85 

Dental  Protective  Associations?  Why  are  There  Two 288 

Dentistry  Among  the  Troops  on  the  Mexican  Border 630 

Dentistry  from  a  Financial  Aspect 100, 165 

Dentists'  Office  Hours 241 

Dentures,  New  Method  of  Constructing  Full 221 

Detachable  Cusp  for  Steele's  Facings 700 

Devitalization,  Shall  we  Discontinue? 207 

Dinshah  Dadabhai  Dordi ^33,  784 

Do  You? 557 

Do  You  Know  That? 644 

Dodge,  Elatharine 448 

I>resch,  L  J 303, 719 


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xii  GENERAL  INDEX  FOR  1916 

PAGE 

Dungan,  F.  L.,  D.D.S 365 

Dunham,  L.  W.,  D.D.S 514,  710,  793 

"D.  W.  B." 434 

D.  W.  H 432 

Duplicates  of  Dental  Publications  at  Vanderbilt  University 718 

Dye,  Ernest  C,  A.  B.,  D.D.S 280 

E 

Efficiency  of  Tmbyte  Teeth 243 

Eighth  Annual  Hay  Fever  Pilgrimage 402 

Eldridge,  Watson,  W.,  M.D 155,  277, 621, 398 

Emetin  vs.  Suigery  in  the  Treatment  of  Pyorrhea 667 

Emplojonent  of  Unlicensed  Assistants 581 

Englander,  Louis,  D.D.S 215 

Engs,  John  S.,  D.D.S 146,  212 

"  E.  S.  G." 27 

Ethics  as  It  is  Lived 787 

Evolution  of  a  Prosthodontist 6 

P^xodontia  under  Nitrous  Oxide  and  Oxygen  Anesthesia 769 

Experiments  to  Determine  the  Toxicity  of  Therapeutic  Agents  in  the  Treatment  of  Py- 
orrhea on  Animal  Cells  Grown  in  Vitro 69 

F 

Failure  to  Sterilize  Instruments  as  Malpractice 652 

Faison,  C.  I.,  D.D.S 30 

Fate  of  An  Innocent  Bystander 345 

Fatigue,  Cause — Nature  and  Cure 398 

"F.  D.  H." 98 

Fees,  Dental 574 

Fees,  How  can  you  Raise,  and  Keep  the  Good  Will  of  the  Community 450 

Fees,  Professional  Denture  Service,  Professional 719 

Feldman,  Bernard,  D.D.S 219, 485 

Fifty-fifty 296 

Finishing  Process  of  Artificial  Dentures 422 

First  Night  in  the  Woods 560 

Flexner,  Simon,  M.D 591 

Food  for  Dentists 155,277,621 

Forsyth,  Thomas,  Banquet  to 781 

Forsyth  Infirmary  for  Children 342 

Forsyth  Loving  Cup,  Hartford  Men  Contribute  to 220 

G 

GaUie,  D.  M.,  D.D.S 89 

Gamble,  B.  L.,  D.D.S 385 

Getting  the  Money 452 

Gift  to  Dental  School 642 

Gillock,  CM., D.D.S 315 

Gold  Crowns  for  Posterior  Teeth  in  Mouth  where  the  Bite  is  Vcr>'  Close 143 

Gold  SheD  Crown  and  Post  for  Short  Teeth 455 

Great  National  Movement 9 

H 

Hartzell,  Thomas  B.,  D.D.S 666 

Haskell,  Loomis  P.,  D.D.S 502,  716,  778 

Healy.  T.  G.,  D.D.S 422 


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GENERAL  INDEX  FOR  1916  ziu 

PAGE 

Higgason,  J.  C,  D.D.S 39© 

HiU,  E.  W.,  D.D.S 384 

Holroyd,  W.  J.,D.D.S 226,640 

Homer,  H.  J.,  D.D.S 640 

How  Can  He  Better  Conditions?  27 

How  to  Make  and  Save  a  Competency 22 

"H.  K." 29 

Howe,  Perry  R.,  D.D.S 782 

Hunting  with  Airedale  Terriers 351 

HunUey,  CarroU,  C,  D.D.S 477 

Hutchinson,  Woods,  M.D 527, 529 

Hygienists,  Dental,  First  Course  for  the  Training  of,  in  New  York 503 

Hygienists,  Dental 284 


Impacted  Third  Molar  Causes  Facial  Paralysis 566 

Importance  of  Suggestion  in  Dental  Practice 724 

Impressions,  Closed  Mouth 4,  74»  i39>  290, 413, 498, 567,  700,  763 

Indictment  Against  Dentist  Quashed 223 

Infection  of  the  Hands  of  Physicians 183 

Inlays  Cost,  What  I  Think, 98 

"Investing  for  the  Rainy  Day  " 652 

J 

Jaulusz,  H.  J.,  D.D.S 217 

Johnsen,  Elberg  V.,  D.D.S 359 

Jones,  Francis  C,  D.D.S 643 

"Josh  ",  A  Reply  to,  in  the  March  Digest 310 

"Josh"  Comes  Back 171 

"J.S." 220 

Juell,  Nils,  D.D.S 293,308 

K 

Kauffmann,  Joseph  H.,  D.D.S 760 

Keyes,  Frederick  A.,  D.D.S 782 

Kurlander,  J.  E.,  D.D.S 219 

Kyes,  Walter  S.,  D.D.S 207, 572 


Larson,  L.  P.,  D.D.S 381 

Launch  Trip,  A 386 

Lay,  Victor,  D.D.S 145 

Layman's  Viewpoint,  A 648 

Lee,  W.B.,  D.D.S 368 

Letter  to  a  Dentist,  An  Original 158 

Liquid  Petroleum 606 

"L.  L." 175 

Living  Costs  and  Dental  Fees 575 

"L.  R." 434 

Ludwig's  Angina 483 

Lupton,  L.  A.,  D.D.S 386 

M 

MacKenzie,  Chas.  M.,  D.M.D 625 

McChesney,  C.  J.,  D.D.S 640 


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xiv  GENBRAL  INDEX  FOR  1916 

PAGE 

McClelland,  W.  Clyde,  D.D.S 416 

McCormlck,  Vance  C 573 

McPhaU,  J.  A.,  D.D.S 394 

Marco,  B.  Banymore,  D.D.S 566 

Marsh,  W.  E.,  D.D.S 784 

"Massachusetts" 112 

Mastication,  Closure  of  Jaw  in 502 

Miller,  J.  M.,  D.D.S 90, 91 ,  376 

M.  L.  C 795 

Mingle,  C.  W.,  D.D.S 516 

Mogh,  WiUiam  C,  D.D.S i 

Molar  Blocks,  Trubyte 294 

Morgan,  Guy,  D.D.S 584 

Mouth  Washes,  Problem  of 625 

Musings  of  a  Simpleton 656 

My  Quest  for  Pike 354 

Myers,  S.  M.,  D.D.S 427 

N 

Nathan,  Charles,  D.D.S 575,  724 

National  Dental  Association,  Twentieth  Annual  Session 409 

National  Dental  License  Association 728 

Natural  Cleansing  of  the  Mouth  by  Natural  Means 485 

Nature,  Manner  of  Conveyance  and  Means  of  Prevention  of  Infantile  Paralysis 591 

New  Method  of  Constructing  Full  Dentures 321 

Nitrous  Oxide  and  Oxygen  Anesthesia,  Exodontia  Under, 769 

"N.  J." 31 

"  N.  M.  D." 22 

O 

Obturators,  Adjusting 217 

Ohm,  W.  H.,  D.D.S 239 

Oral  Prophylaxis,  The  Dentist,  the  Patient  and, 760 

Orthodontia  of  the  Deciduous  Teeth 631 ,  691,  757 

Orthodox  Orientals  and  Their  Freedom  from  Pyorrhea  Alveolaris 531 

Our  Vacation  in  1915 390 

Our  Wisconsin  River  Trip 374 

P 

Partial  Dentures 526 

Patient  Frankly  Leaves  the  Reward  to  God 241 

Perkins,  Bertram  R.,  D.D.S 769 

"Perplexed" 220 

Phelps,  D.  R.,  D.D.S 722 

Phillips,  M.  G.,  D.D.S 763 

Platinum,  Separating  Gold  From 427 

Piatt,  Frank  L.,  D.D.S 577 

Practical  Illustration  of  Success 506 

Practice,  Business  Side  of  Prophylactic  and  Restorative 19 

Pray,  K.  D.,  D.D.S 294 

Preventive  Dentistry  and  the  Dental  Nurse 529 

Prime,  J.  M.,  D.D.S 222 

Problem  of  Mouth  Washes 625 

Professional  Denture  Service  or  Professional  Fees? 719 

Professional  Discourtesy 431 


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GENERAL  INDEX  FOR  1916  zv 

PAGE 

Progressive  Prosthetic  Clinic 705,  707 

Proof  of  Malpractice  in  Dentktr>' 234 

Proposed  Statement  of  Aims  and  Objects 247 

Pyorrliea  Alveolaris,  Orthodox  Orientals  and  Their  Freedom  From 531 

Pyorrhea  and  the  General  Health 641 

Pyorrhea,  Treatment  of,  for  the  General  Practitioner , 601 

Q 

QUESTIONS  AND  ANSWERS ....       41, 115-116, 179,  246, 315, 455-457,  S23,  59©,  663,  733 

R 

Rafidin  Ahmed,  D.D.S 786 

Rapid  and  Accurate  Method  of  Soldering  Pin  to  Richmond  Cap 565 

Rationale  of  Riggs'  Disease 553 

Records,  Necessity  for  Completing  Complete 300 

Rdd,  J.  G.,  D.D.S 89 

Relation  of  the  Dentist  to  the  Manufacturer  and  Dealer 584 

Repairing  Carious  Teeth 642 

Reply  to  "M.  F.  R." 29 

Richmond,  Harvey.  D.D.S 642 

Robertson,  T.  M.,  D.D.S 402 

Ross,  F.  Z.,  D.D.S 103 

"R.  R.  C." 148 

Rugae 145 

S 

Saving  Time  in  Impression  Taking, 786 

Saving  for  the  Rainy  Day  and  Old  Age  Fund 517 

Scovil,  Raymond,  D.D.S 143 

Seccombe,  Wallace,  D.D.S 305, 444, 511 

Selection  of  Teeth 424 

Selling  Denture  Service 303 

Separating  Gold  from  Platinum 427 

Septic  Wheel  Brush,  The 148 

Shearer,  William  L.,  D.D.S 172 

Sherman,  W.  Goddard,  D.D.S 149,  562 

Shortage  of  General  Practitioners 78 

Shoulder  Crown  and  Its  Technic 643 

"S.  H.  W." 786 

Some  Thoughts  on  the  Business  Side  of  Practice 722 

Something  Different 364 

Spare  the  Toothbrush,  Spoil  the  Joints 527 

Specific  for  Poison  Oak  or  Ivy 365 

Spence,  Stewart  J.,  D.D.S 491,  557 

Spies,  W.  F.,  D.D.S 19, 69, 94, 159,  435 

Splint,  An  Intermaxillar>' 64S» 

Stein,  J.  J.,  D.D.S 521 

Stekl,  C.  F.,  D.D.S 374 

Street,  A.  L.  H 234,  310,  510,  552,  580 

Strong  Man's  Song 552 

Successful  Deer  Hunt  in  Massachusetts 380 

Successful  Practice  of  Dentistry 305, 444, 511 

Sugar  and  Its  Effect  Upon  the  Teeth 146,  212 

Suggestion  in  Dental  Practice,  Importance  of 575 


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zvi  GENERAL  INDEX  FOR  1916 

PAGE 

Supplee,  Samuel  G 4,  74,  i39»  290, 413*  498»  567,- 700,  764 

Sure  Cure  and  a  Pleasant  One 381 

System  of  Dental  Bookkeeping 103 

T 

Taggart  Cannot  Sue  the  Dentists  Collectively 504 

Taylor,  L.  C,  D.D.S 661 

Tench,  Russell  W.,  D.D.S 561 

The  Beach  or  Mountains? 372 

The  Blaster 180 

The  Fate  of  An  "Innocent  Bystander" 345 

The  Whole  World  is  a  Big  Store 449 

Too  Busy  to  Read 206 

Tooth  Bleaching,  Technicof  Natural,  in  the  Mouth 215 

Tooth  Brush,  Care  and  Use  of  the 222 

Tooth  Brush?  Why  Discard  the 280 

Towne,  Wm.  E.,  D.D.S 237 

Treatment  of  Fractured  Jaws 4 

Trubyte  Molar  Blocks,  Perfect  Articulation  in  Posterior  Bridgework  by  the  Use  of 294 

Turner,  G.  Grey,  M.  S.,  F.  R.  C.  S 182  . 

Turpentine,  Oil  of,  as  a  Haemostatic 182 

Twichell,  Charles  L.,  D.D.S 380 

Two  T>'pical  American  Faces 573 

U 

Uncle  Mack 452 

University  Dental  School  in  New  York  for  Columbia 225 

Up  the  Oswego  After  Trout 405 

V 

Valuable  Suggestions  in  Training  Assistants 495 

Vulcanite,  Expansion  and  Contraction  in  Plaster  and 491 

AV 

Walters,  W.  S.,  D.D.S 354 

"Washington  ** 112 

Waterbury,  J.  E.,  D.D.S 495 

Weaver,  C.W.,  D.D.S 362 

Webster,  Guy  B.,  D.D.S 504 

Weed,  Thomas  M.,  D.D.S 655 

Week  at  Lake  Geneva,  Wisconsin 35v 

Weeks,  Sinclair,  D.D.S 6 

What  a  Vacation  Did  for  Me 366 

What  Do  You  Believe? 793 

What  I  Like  About  My  DenUst 18 

What  I  Think  Inlays  Cost 98 

What  Shall  We  Charge  for  Plates? 226 

Where  Have  My  Profits  Gone? 308 

Why  a  Vacation  and  Where 394 

Why  I  Think  It  Pays  to  be  Courteous 514 

Who  is  Responsible  for  Low  Fees? 576 

Willcox,  W.R 573 

Woodle,  J.  M.,  D.D.S 565 

Wrongful  Discharge  of  Dentist 151 

Z 
Zimmerman,  L.  M.,  D.D.S *. 424, 372 


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The  Dental  Digest 

GEORGE  WOOD  CLAPP,  D.D.S.,  Editor 

Published  monthly  by  The  Dentists'  Supply  Company,  Candler  Bldg., 
Times  Square,  220  West  42d  Street,  New  York,  U.  S.  A.,  to  whom  all  com- 
munications relative  to  subscriptions,  advertising,  etc.,  should  be  addressed. 
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Articles  intended  for  publication  and  correspondence  regarding  the  same 
should  be  addressed  Editor  Dental  Digest,  Candler  Bldg.,  Times  Square, 
220  West  42d  Street,  New  York,  N.  Y. 

The  editor  and  publishers  are  not  responsible  for  the  views  of  authors  ex- 
pressed in  these  pages. 

Entered  as  Second  Class  Matter,  at  the  Post-Ofl5ce  at  New  York  City. 
Under  the  Act  of  Congress,  March  3,  1879. 


Vol.  XXII 


JANUARY,  I9I6 


No.  1 


TREATMENT  OF  FRACTURED  JAWS 

William  C.  Mogh,  D.D.S.,  Brooklyn,  N.Y. 
Case  I 

Patient — Mr.  N.    Age — 50  years. 

History — ^Was  kicked  in  the  face  by  a  horse,  causing  a  compound  frac- 
ture of  the  superior  maxilla.  Was  admitted  to  the  Williamsburg  Hos- 
pital, Brooklyn,  on  July  6th,  1915,  in  the  service  of  Dr.  Robt.  Morrison, 
visiting  surgeon. 

I  was  called  in  on  the  case  by  the  hospital  and  found  the  patient  in 
great  pain.  He  had  a  temperature  of  105  and  his  mouth  was  a  mass  of 
splintered  bone,  process  and  pus.  It  took  fifteen  minutes  of  steady 
irrigation  to  get  the  mouth  in  a  condition  before  I  could  see  anything  at 
all.  Upon  close  examination  I  foimd  the  patient  to  be  suffering  from  a 
compound  fracture  of  the  upper  maxilla,  one  break  being  between  the 
lateral  incisor  and  canine  of  the  right  side,  and  the  other  between  the 
lateral  incisor  and  canine  on  the  left  side.  He  had  also  a  simple  fracture 
of  the  mandible  on  the  right  side,  between  the  first  bicuspid  and  the 
canine. 

In  Figure  i  we  have  a  diagram  of  the  fracture  in  the  superior  maxillae. 

The  pain  from  touch  was  so  great,  that  the  patient  had  to  be  taken  to 
the  operating  room,  where  I  took  the  impression,  first  having  wired  the 


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2  THE  DENTAL  DIGEST 

case,  to  be  sure  the  parts  would  not  move  when  the  material  was  forced 
in.  From  this  impression  I  made  a  rubber  splint  which  besides  covering 
the  teeth  from  the  one  first  bicuspid  to  the  corresponding  tooth  on  the 
other  side,  also  covered  the  palatal  surface  of  the  bone,  and  held  the  parts 
tightly  in  their  normal  relationship. 

The  fracture  of  the  mandible  was  a  simple  one  as  is  shown  in  Figure  2. 


Fig.  I.    Showing  fracture  of  superior  maxilla 


Fig.  2.    Showing  pK)int  of  fracture 

I  took  the  impression  with  modeling  compound,  holding  the  two  parts 
together.  From  the  model  of  the  impression  the  gold  splint  was  swaged 
and  then  cemented  on. 

The  case  was  dismissed  in  sixty  days,  when  the  patient  was  able  to 
use  his  mouth  as  he  had  done  before  the  accident. 


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TREATMBNT  OF  FRACTURED  JAWS  3 

Case  II 

Patient — ^J.    Age — 7  years. 

History — Was  run  over  by  a  wagon  causing  a  fracture  on  the  right  side 
of  the  mandible.  Was  admitted  to  the  Williamsburg  Hospital,  Brooklyn, 
on  October  i6th,  1915,  in  the  service  of  Dr.  Robt.  Morrison  visiting 
surgeon. 

Being  called  upon  to  take  charge  of  the  case  I  immediately  looked  for 
crepitis,  which  I  found  on  the  right  side  of  the  mandible,  as  is  shown  in 
Figure  i. 


Fig.  I,  Case  2.    Showing  the  point  of  fracture 
T.    Temporary  molar;  2.  Temporary  molar;  3.  Temporary  canine  or  cuspid;  4.  Perman- 
ent lateral  incisor;  5.  Permanent  central  incisor;  6.  Point  of  fracture. 


Fig.  2,  Case  2.    Showing  gold  splint  in  place 
I.    Gold  splint  in  place  cemented  to  the  teeth;  2.  •  Fracture  in  perfect  contact. 

It  being  a  case  of  a  simple  fracture,  I  took  an  impression  in  modeling 
compound,  being  very  careful  to  have  my  assistant  in  the  case  hold  the 
jaw  at  the  angle  and  the  chin,  making  certain  that  there  would  be  no 
chance  of  the  patient  moving  and  getting  an  incorrect  impression.  I 
then  took  a  bite  with  soft  wax  to  get  good  occlusion.  The  models  were 
then  made  from  the  impression  and  bite,  and  from  the  model  the  splint 
was  swaged,  and  then  soldered,  making  a  continuous  gold  splint,  as  is 
shown  in  Figure  H. 

In  thirty-three  days  I  took  off  the  splint,  and  the  patient  had  once 
more  a  perfect  jaw  and  bite. 

223  St.  Nicholas  Ave. 


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4  THE  DENTAL  DIGEST 

CLOSED  MOUTH  IMPRESSIONS 

By  Samuel  G.  Supplee,  New  York 

First  Article 
certain  preliminary  considerations 

When  I  was  graduated  from  dental  college  to  practical  work,  plaster  was  re- 
garded as  the  only  proper  material  for  taking  impressions.  After  a  year  of 
partial  successes  mixed  with  some  complete  failures,  I  met  a  dentist  who  had 
learned  how  to  whittle  and  scrape  models  so  that  plates  made  over  them  would 
stay  up.  I  lunched  with  a  denture  patient  once  and  was  mortified  to  see  him 
take  out  his  plates  "so  he  could  eat." 

I  spent  some  years  in  the  study  of  anatomical  articulation  without  giving 
much  thought  to  the  impressions.  Those  who  followed  the  published  methods 
achieved  better  success  than  before,  but  certain  failures  of  the  dentures,  not 
connected  with  articulation,  were  discomforting.  I  know  now  that  those  fail- 
ures originated  in  faulty  impressions,  bites,  and  models. 

Then  Mr.  Supplee  showed  me  things  about  impressions,  of  which  I  had 
never  dreamed.  I  saw  that  the  best  articulated  dentures  might  fail  from  unsci- 
entific impression  taking  and  cast  making  methods.  I  saw  him  succeed  with 
case  after  case  where  I  should  have  stood  no  chance  of  success.  Sometimes  he 
had  to  try  more  than  once,  but  he  succeeded  where  from  5  to  15  dentists  failed. 
And  he  succeeded  because  he  has  learned  how  to  take  impressions  and  bites 
and  pour  models  and  arrange  teeth  and  vulcanize  in  a  scientific  manner, 

I  am  very  glad  to  have  the  opportunity  of  bringing  the  fruits  of  Mr.  Supplee's 
work  to  the  readers  of  this  magazine.  I  am  sure  that  those  who  follow  his 
methods  will  achieve  greater  success  than  by  any  other  methods  I  know  of. 

When  the  methods  in  all  steps  of  denture  making  become  scientific,  we  shall 
regularly  achieve  as  great  successes  in  this  field  as  in  operative  work.  We  shall 
then  be  much  better  dentists  and  shall  more  nearly  fulfil  our  mission  of  render- 
ing good  service  to  edentulous  patients. — Editor. 

The  phrase  "taking  an  impression  and  pouring  a  cast"  has,  for  years, 
indicated  practically  all  there  was  to  be  said  of  the  technic  of  preparing 
a  foundation  on  which  a  plate  is  constructed. 

'*  Fitting  a  plate  "  has  been  the  expression  to  describe  the  hours  of  filing 
and  trimming  after  the  plate  has  been  vulcanized. 

It  has  been  well  said  that  denture  making  by  the  old  methods  has 
been  mostly  guesswork,  and  that  the  honors  have  usually  gone  to  the 
best  guesser,  or  to  him  who  was  most  skillful  with  scraper,  stone  or  file. 
The  arrangement  of  the  teeth  by  the  old  methods  of  occlusion  and  on  the 
old  forms  of  articulators  has  also  been  mostly  guesswork. 

Among  the  questions  which  confront  those  who  wish  to  do  really  pro- 
fessional service  in  dentures  are  the  following: — Shall  we  aim  to  obtain 
impressions  of  the  mouth  from  which  to  construct  dentures  in  the  usual 
way,  or  shall  we  construct  in  the  mouth  trial  plates  which  will  properly 
compress  or  displace  soft  tissues  and  at  the  same  time  hold  the  lips,  and 
cheeks  out  to  the  positions  necessary  for  restoration  of  expression  and  du- 


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CLOSED  MOUTH  IMPRESSIONS  5 

plicate  these  in  the  finished  dentures?  The  second  question  is:  Shall  we 
p)our  casts  in  plaster,  which  expands  and  which  is  easily  compressed  in  the 
flask  press  or  by  the  expanding  vulcanite,  or  shall  we  pour  casts  in  materials 
which  are  less  subject  to  changes  and  less  likely  to  defeat  our  best  efforts? 

In  my  article  entitled  "The  Importance  of  Taking  Impressions  With 
the  Mouth  Closed  and  Under  Biting  Pressure,"  published  in  the  October 
1914  issue  of  this  magazine,  I  called  attention  to  the  difference  between 
an  impression  with  the  mouth  open  and  the  mouth  closed.  Many  den- 
tists have  formed  the  opinion  that  the  difference  between  impressions  with 
the  mouth  open  and  the  mouth  closed  constitutes  the  secret  by  which 
those  who  have  made  careful  studies  of  mouths  and  materials  have  been 
able  to  make  successful  dentures  for  patients  for  whom  all  previous  den- 
tures have  been  unsuccessful. 

Many  have  gained  the  idea  that  all  they  need  to  insure  success  is 
water  heating  apparatus,  a  set  of  trays  and  some  modelling  compound. 
The  results  of  their  impressions  with  closed  mouths  and  properly  heated 
modelling  compound  has  been  that  their  dentures  have  been  more  success- 
ful than  ever  before,  but  that  a  certain  percentage  of  these  cases  has  been 
successful  for  only  a  short  time.  The  temporary  nature  of  these  successes 
has  been  due  to  imperfect  conceptions  of  the  mouth,  of  the  materials 
employed  and  the  methods  best  suited  to  their  uses. 

In  addition  to  this,  they  have  not  grasped  the  idea  that  when  no  pres- 
sure is  appUed  to  a  plate,  it  rests  on  the  soft  tissues,  but  when  biting  pres- 
sure is  applied,  the  plate  is  forced  against  the  soft  tissues  until  they  are 
either  condensed  or  displaced  into  positions  and  conditions  in  which  the 
soft  tissues  and  the  hard  tissues  bear  the  strain  equally.  This  is  equal- 
izing the  tissues  to  withstand  biting  strain.  The  successes  mentioned 
above  were  temporary  only  because  of  the  employment  of  improper 
methods  in  condensing  or  displacing  soft  tissues. 

To  eliminate  guesswork  from  denture  making,  one  must  replace  the 
rule  of  thumb  methods  of  the  past  in  impression  and  bite  taking,  arrange- 
ment of  the  teeth  and  laboratory  work,  with  the  scientific  methods  now 
offered  in  all  these  lines.  For  instance,  both  dentists  and  laboratory 
workers  will  profit  by  recognizing  that  plaster  begins  to  expand  as  soon  as 
it  is  set,  and  is  easily  compressible,  and  to  the  extent  that  it  is  affected  by 
these  changes  is  unreUable.  During  vulcanization  the  vulcanite  first 
expands  then  shrinks  and  finally  warps.  Unless  care  is  exercised  to  guard 
against  these  changes,  our  finest  efforts  may  be  frustrated  by  failures  due 
to  change  in  form  of  materials. 

These  changes  in  form  can  be  guarded  against  by  properly  pouring 
casts  of  the  non-expanding  and  practically  non-compressible  materials 
such  as  Weinstein's  Artificial  Stone,  Spence's  Plaster,  etc. 


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6  THE  DENTAL  DIGEST 

In  mouths  where  the  muscular  attachments  are  not  pronounced  and 
the  vault  and  ridges  are  of  equal  density  all  over,  we  can  take  impressions 
in  plaster,  or  any  other  kind  of  impression  material  regardless  of  the  size 
of  the  tray,  with  the  expectation  that  successful  dentures  will  result. 
But  even  the  prosthetic  speciaUsts  have  been  obliged  to  admit  that  in 
cases  which  present  difficulties  from  character  of  tissue  or  of  form,  model- 
Ung  compound  is  far  superior  to  plaster  as  an  impression  material. 

In  this  series  of  articles  I  shall  outline  a  technic  of  diagnosing  condi- 
tions in  the  mouth,  of  impression  taking  and  of  bite  making  which  has 
been  successful  in  many  cases  where  all  other  forms  of  techm'c  have  failed. 
(This  article  is  expected  to  be  continued) 


THE  EVOLUTION  OF  A  PROSTHODONTIST 

By  Sinclair  Weeks,  D.D.S.,  New  York 

This  article  was  awarded  the  Fourth  Prize  in  the  Prosthetic  Articles  Contest. 

Just  before  entering  college  to  take  up  my  studies  in  dentistry,  I  was 
fortunate  in  meeting  a  dentist  of  the  old  school  who  was  ripe  in  experience 
as  well  as  years,  who  offered  me  a  few  words  of  advice  which  must  have 
burned  deeply  into  my  sub-conscious  memory  for  they  have  stayed  by 
me  for  twenty  years.  They  were  as  follows — *' Young  man  your  success 
in  this  field  will  largely  depend  upon  whether  or  not  you  possess  a  mechan- 
ical sense.  If  you  do  you  can  put  it  to  no  better  use  than  to  cultivate  the 
highest  degree  of  skill  in  the  construction  of  artificial  teeth.  It  takes  a 
patient  from  six  months  to  five  years  to  find  out  what  kind  of  gold  filling 
you  have  inserted  for  him,  but  it  only  takes  a  few  weeks  to  find  out  if  you 
have  made  him  a  useful  set  of  teeth." 

It  was  a  long  time  before  I  fully  comprehended  the  significance  of  that 
advice  and  started  out  to  follow  it.  After  I  was  graduated  and  went  out 
into  the  world  to  become  acquainted  with  my  chosen  profession  I  found 
the  majority  of  dentists  had  either,  through  lack  of  ability  or  indifference, 
pulled  or  pushed  this  very  important  branch  of  dentistry  down  to  a  low 
level  and  belittled  it  by  calling  it  common  plate  work  and  relegated  it  the 
office  girl  or  an  outside  laboratory.  I  determined  to  meet  the  very  first 
opportunity  which  should  present  itself  to  allow  me  to  perfect  myself 
along  these  lines.  Shortly  after  I  went  into  a  laboratory  in  a  small  city 
with  an  ethical  man  to  **work  out  my  salvation." 

I  received  some  pretty  severe  jolts  in  the  next  few  weeks  when  I  saw 
many  of  the  important  methods  of  technique  which  had  been  quite  a 
respectable  part  of  my  college  education  thrust  aside  and  in  their  place  a 

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THE  EVOLUTION  OF  A  PROSTHODONTIST  7 

slip-shod  trusting-to-luck-method.  I  was  taught  that  excessive  stirring 
of  plaster  caused  great  expansion,  but  I  saw  it  mixed  here  as  one  would 
whip  cream.  I  learned  at  college  that  the  correct  way  to  take  a  bite 
was  to  fit  plates  to  casts  with  a  stiff  material  and  build  them  up  with 
compound,  but  here  I  saw  a  roll  of  beeswax  thrust  between  the  jaws  and 
the  patient  told  to  bite.  I  had  cause  to  wonder  if  there  was  any  standard 
of  articulation,  when  I  saw  teeth  set  up  on  the  barn  door  hinge,  and  when 
I  finally  dared  to  offer  a  mild  protest,  I  was  told  that  I  was  only  talking 
theory  and  that  plate  work  in  reaUty  was  very  simple  and  that  I  would 
soon  master  it,  if  I  cut  out  the  theory  and  came  down  to  simple  practice. 

Experience  is  not  only  a  great  teacher,  but  it  plays  an  important  part 
in  raising  our  standards.  When  a  year  or  so  later,  I  started  in  business 
for  myself  I  was  glad  to  be  free  to  carry  out  some  of  the  ideas  which  had 
been  handed  down  from  the  men  who  had  gone  before  and  I  learned 
as  we  all  do  sooner  or  later,  that  there  is  no  short  cut  to  success.  After 
trying  to  take  a  few  short  cuts,  I  got  right  back  to  first  principles  and  gave 
up  the  idea  that  plate  work  was  "simple,"  I  suppose  I  must  have  met 
with  a  certain  degree  of  success  for  business  began  to  come  my  way  and 
I  began  to  acquire  a  reputation  as  a  plate  maker.  As  I  look  back  and 
think  about  the  plates,  I  turned  out  I  am  pretty  sure  it  took  more  skill  to 
manipulate  them  than  it  did  to  construct  them. 

As  the  months  went  by  I  began  to  see  the  importance  of  this  much 
neglected  work;  in  place  of  drudgery,  I  saw  that  if  one  really  possessed  a 
mechanical  sense  it  became  more  and  more  pleasant  if  not  really  fascin- 
ating. I  saw  that  if  one  was  to  consider  it  serious  business  it  meant  care- 
ful study  of  each  step  of  the  process  in  the  construction  of  a  plate.  That 
a  perfectly  fitting  denture  was  never  the  result  of  guess  work  or  luck. 
That  because  a  plate  might  be  good  enough  it  was  not  necessarily  just 
right.  Two  important  steps  I  learned  were  essential,  namely — a  perfect 
impression  and  a  perfect  bite.  This  I  held  to  tenaciously  and  my  per- 
severence  was  rewarded  to  a  satisfying  degree.  I  ajso  saw  that  if  I  was 
to  excel  I  must  go  a  little  farther  than  the  other  fellow  so  I  began  to  carve 
the  gums.  I  always  directed  the  patient's  attention  to  this  and  it  made  a 
good  impression.  I  also  vulcanized  over  thin  gold  foil.  This  also  pleased 
patients.  I  was  careful  to  see  that  my  plates  were  as  thin  as  consistent 
with  strength.  The  next  year  the  Anatomical  moulds  came  on  the  mar- 
ket and  this  gave  me  an  opportunity  to  increase  prices.  I  started  in  to 
educate  my  patients  to  see  that  there  was  a  difference  in  plates,  and  in- 
variably foimd  that  if  the  pubUc  was  made  to  see  by  frank  honest  business 
talk  that  they  were  getting  something  better  than  the  ordinary  article 
they  were  perfectly  willing  to  pay  for  it.  Occasionally  I  would  meet  a 
patient  who  thought  plates  were  plates  regardless  of  how  they  were  made 

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8  TH£  DENTAL  DIGEST 

and  would  try  to  induce  me  to  reduce  my  fee.  I  held  rigidly  to  my  scale 
of  prices  and  explained  to  him  that  if  I  attempted  to  economize  he  would 
be  the  loser.  I  recall  one  man  who  was  in  very  comfortable  circum- 
stances and  perfectly  able  to  pay,  objecting  to  my  prices  and  leaving 
the  office,  saying  he  would  like  to  have  me  do  the  work  but  that  he  wo\ild 
never  pay  that  price  if  he  went  without  teeth  all  his  life.  Imagine  my 
surprise  when  he  returned  to  my  office  a  year  later  and  told  me  he  had 
dedded  to  have  the  work  done.  Two  years  later  I  moved  to  a  larger 
field  with  greater  opportunities  to  study  improved  and  up-to-date  meth- 
ods. I  found  as  I  had  in  the  small  city^  but  in  a  much  greater  degree,  a 
broad  and  unlimited  field  with  opportunity  continually  pounding  at  the 
door  of  the  man  who  could  excel  in  high  class  plate  work.  I  attended 
lectures  and  clinics  and  saw  prosthetic  dentistry  advancing  by  leaps  and 
bounds.  I  secured  the  Prosthetic  Articulation  and  mastered  the  princi- 
ples involved  in  the  Greene-Supplee  method  of  taking  compound  im- 
pressions, I  became  dissatisfied  with  trying  to  fit  stock  trays,  secured  a 
flask  and  thereafter  cast  my  own  trays. 

With  the  appearance  of  Trubyte  teeth  on  the  market  I  began  to  talk 
efficiency  as  well  as  appearances.  Discarding  the  illogical  and  out  of  date 
temperamental  theory  I  drew  an  outline  of  the  face  and  selected  the  teeth 
according  to  the  Williams  classification.  By  this  method  I  have  been 
able  to  select  teeth  that  will  harmonize  with  facial  outline.  I  always  set 
up  the  teeth  on  a  Gysi  articulator  and  try  them  in  before  vulcanizing.  I 
finish  the  upper  plate  first  and  insert  it  to  see  that  the  bite  is  correct  with 
the  lower  teeth  which  are  still  in  the  wax.  This  enables  me  to  secure  a 
perfect  articulation. 

At  present  I  carve  the  gums  and  insert  the  rugae.  I  vulcanize  all 
plates  over  Spence's  plaster  models  to  eliminate  expansion  and  secure  the 
necessary  strength  to  resist  breakage  in  the  flask.  I  always  take  time 
(and  consider  it  a  most  profitable  investment)  to  explain  all  these  ad- 
vantages to  my  patients.  I  have  no  trouble  to  secure  satisfactory  com- 
pensation. I  hope  the  next  ten  years  will  see  prosthetic  dentistry  solidly 
placed  on  the  high  level  in  the  profession  where  it  logically  belongs. 


Editor  Dental  Digest: — 

What  is  the  best  thing  to  do  for  a  three  year  old  girl  who  breathes 
through  the  mouth  at  night  and  snores  as  loud  as  an  adult? 

The  physician  says  she  has  no  adenoids.     She  has  been  breathing  and 
snoring  this  way  for  about  three  weeks. 

W.   B.  B. 


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A  GREAT  NATIONAL  MOVEMENT  9 

A  GREAT  NATIONAL  MOVEMENT 

Objects  and  Accomplishments  of  The  National  Mouth  Hygiene 
Association  result  in  interesting  plans  for  the  future 

By  W.  G.  Ebersole,  M.D.,  D.D.S., 
Secretary-Treasurer-General  of  The  N.  M.  H.  A. 

When  Miss  Cordelia  L.  O'Neill,  who  was  then  principal  of  Marion 
School  in  Cleveland,  presented  to  the  National  Dental  Association  at  its 
meeting  in  Cleveland  in  1911,  and  later  at  the  Fourth  International  Con- 
gress on  School  Hygiene,  the  twenty-seven  members  of  her  class  as  a 
living  demonstration  of  what  Mouth  Hygiene  could  accomplish,  the 
establishment  of  a  national  association  was  no  longer  a  question.  The 
visible  evidence  of  the  physical  and  mental  transformation  wrought  in 
those  children  was  greeted  by  the  audience  with  a  demonstration  of  en- 
thusiasm that  will  never  be  forgotten  by  anyone  who  was  present. 

The  National  Mouth  Hygiene  Association  was  formed  as  an  auxiliary 
of  the  National  Dental  Association  July  28th,  1911 ,  in  order  to  unite  under 
one  efficient  national  organization  the  various  oral  hygiene  working  forces 
of  the  country.  It  has  already  a  record  of  achievement  of  which  both 
the  professional  and  lay  members  may  justly  be  proud  and  which  should 
enlist  the  interest  and  support  of  the  entire  dental  profession. 

Among  many  laudable  motives  back  of  this  national  movement  are 
the  following,  which  appear  in  the  preamble  to  the  constitution  and  by- 
laws of  the  Association,  as  adopted  at  a  meeting  in  Washington,  D.  C, 
last  May: 

1.  The  teaching  of  Mouth  Hygiene  and  its  relation  to  better  health, 
increased  mental  and  physical  working  efficiency,  and  consequent  greater 
happiness; 

2.  To  provide  both  the  expert  service  and  the  funds  necessary  to  en- 
able the  organized  dental  profession  in  every  community  to  do  those 
things  that  are  for  the  best  interests  of  its  people; 

3.  To  direct  the  attention  of  parents  and  guardians  to  the  importance 
of  dental  services  especially  in  childhood; 

4.  To  eliminate  the  dental  fakirs,  charletans  and  fraudulent  adver- 
tisers who  subsist  on  the  ignorance  and  credulity  of  the  public; 

5.  To  teach  Preventive  Dentistry  and  to  recommend  the  employment 
of  the  highest  t)q)e  of  professional  services; 

6.  To  promote  the  efficiency  of  the  organized  dental  profession  in- 
dividually and  collectively  and  to  give  it  a  wider,  more  responsive  and 
more  intelligent  field  in  which  to  work; 


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10  TH£  DENTAL  DIGEST 

7.  To  bring  together  actively  not  only  the  serious  workers  in  the 
dental  profession,  but  people  of  all  other  professions  and  vocations,  and 
to  enlist  their  united  interest  and  cooperation  in  the  expansion  of  the 
propaganda  of  Preventive  Dentistry  and  Mouth  Hygiene; 

8.  To  act  as  a  servant,  aid  and  auxiliary,  to  both  the  organized  dental 
profession  and  the  American  public  to  secure  and  retain  the  highest  and 
most  permanent  benefits  for  all,  through  the  realization  of  the  objects 
first  stated: 

The  incorporation  of  the  Association  under  its  present  title,  however, 
didn't  take  place  until  the  annual  meeting  of  the  National  Dental  Associ- 
ation at  Rochester,  N.  Y.,  in  July,  1914.  It  is  a  corporation  not  for 
profit,  and  exists,  as  stated  in  the  paragraphs  just  quoted,  for  philanthropic 
ends. 

There  is  no  question  but  that  the  influence  of  the  Association  has  been 
one  of  the  chief  forces  in  bringing  about  a  more  enlightened  public  opinion 
on  the  subject  of  Mouth  Hygiene  in  its  relation  to  public  health. 

The  importance  of  the  movement  has  been  fully  recognized  by  na- 
tional, state  and  local  boards  of  health,  by  school  boards  all  over  the 
country,  and  by  individuals  and  organizations  interested  in  social  wel- 
fare, while  many  of  the  leading  men  of  the  dental  profession  have  given 
freely  of  their  time,  money  and  influence. 

The  responsiveness  of  the  public  has  been  made  evident  from  the  very 
beginning,  not  only  by  the  interest  shown  in  public  dental  clinics,  but  by 
the  private  donations  for  their  support — notably  at  Boston,  Rochester 
and  Cleveland.  This  evidence,  together  with  such  encouraging  indica- 
tions as  the  extensive  welfare  work  under  municipal  auspices  at  New  York, 
Buffalo,  Philadelphia,  Detroit  and  Cincinnati,  show  the  seriousness  with 
which  need  of  better  Mouth  Hygiene  is  regarded. 

The  Assodation  has  from  the  first  been  identified  with  related  health 
organizations.  It  participated  in  the  Fifteenth  International  Congress 
on  Hygiene  and  Demography  at  Washington,  in  191 2,  conducted  a  special 
session  at  the  Fourth  International  Congress  on  School  Hygiene  at  Buf- 
falo in  1913,  and  a  joint  session  with  the  Forty-Second  Annual  Meeting 
of  the  American  Public  Health  Association  at  Jacksonville,  Fla.,  in  1914. 

When  Mr.  Taft  was  President  of  the  United  States  he  recognized  the 
Association  officially,  and  it  has  been  endorsed  by  many  state  and  local 
dental  societies  and  prominent  leaders  in  education,  social  and  industrial 
betterment  and  general  hygiene. 

This  success  of  the  Association  has  doubtless  been  largely  due  to  the 
fact  that  its  founders  recognized  the  need  of  organization  from  the  outset, 
and  elected  a  body  of  officers  and  a  Board  of  Governors,  composed  of  men 
and  women  whose  reputation  is  a  guaranty  of  an  efficient  service. 


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A  GREAT  NATIONAL  MOVEMENT  11 

The  President  of  The  National  Mouth  Hygiene  Association  is  Dr. 
Harvey  W.  Wiley,  the  great  pure  food  expert,  former  chief  of  the  U.  S. 
Bureau  of  Chemistry. 

Among  the  vice  presidents  are  Dr.  Rupert  Blue,  Surgeon-General  U. 
S.  Public  Health  Service,  and  now  President  of  the  American  Medical 
Association;  Dr.  W.  A.  Evans,  ex-health  commissioner  of  Chicago,  now 
editor  of  the  Health  Department  of  the  Chicago  Tribune;  Dr.  Oscar 
Dowling,  President  of  the  Louisiana  State  Board  of  Health;  and  William 
R.  Malone,  President  of  the  Postal  Life  Insurance  Co. 

Turning  to  the  Board  of  Governors  we  note  such  names  as  those  of 
Prof.  Irving  Fisher  of  Yale  University,  Chairman  of  the  Hygiene  Refer- 
ence Board;  Miss  Julia  C.  Lathrop,  Chief  of  the  Children's  Bureau  of  the 
U.  S.  Department  of  Labor;  while  Dr.  John  W.  Kerr,  Assistant  Surgeon- 
General,  U.  S.  Public  Health  Service;  Mr.  Lewis  Meriam,  Assistant 
Chief  of  Children's  Bureau  of  the  U.  S.  Department  of  Labor;  Mr.  F.  B. 
Dressier,  Specialist  in  School  Hygiene  &  Sanitation,  Bureau  of  Education, 
Department  of  the  Interior,  have  pledged  service  in  research  and  exten- 
sion work,  and  several  of  the  U.  S.  Bureaus  have  been  placed  at  the  dis- 
posal of  the  Association  in  promoting  its  propaganda. 

The  working  methods  of  the  Association  include  extensive  campaigns 
in  different  cities  for  the  double  purpose  of  community  education  and  the 
raising  of  funds,  a  strong  dental  publicity  department  which  secures  wide 
publication  of  all  news  relating  to  the  movement  and  many  highly  educa- 
tional articles  on  Mouth  Hygiene;  and  active  cooperation  with  the  work 
of  allied  organizations.  One  of  the  great  objectives  is  the  establishment 
of  public  dental  clinics  and  school  clinics  in  every  town  and  city. 

The  prosecution  of  the  work  is  assisted  by  the  establishment  of  local 
auxiliaries,  the  Association  furnishing  the  expert  service  to  organize, 
finance  and  equip  these  auxiliaries  in  a  manner  which  insures  definite 
results  and  continued  self -support,  and  around  which  can  be  centred  the 
work  of  each  community.  Auxiliaries  have  already  been  formed  at 
Dallas,  Texas;  Cleveland,  Ohio;  Washington,  D.  C;  Portland,  Oregon; 
Kansas  City,  Mo.;  Dayton  O.;  Canton,  O.,  and  Jacksonville,  Fl'a.,  and 
the  Association  is  proceeding  as  rapidly  as  possible  to  place  these  on  a 
successful  working  and  supporting  basis. 

Many  other  communities  have  taken  steps  toward  the  establishment 
of  active  auxiliaries  and  may  be  expected  to  follow  the  examples  of  those 
already  mentioned.  Among  them  are  Louisville,  Ky.;  Joliet,  111.;  At- 
lanta, Ga.;  Duluth,  Minn.;  Mobile,  Ala.,  and  Lynchburg,  Va. 

It  is  with  a  great  deal  of  satisfaction  that  we  call  attention  to  our  De- 
partment of  Extension  Lectures  under  the  supervision  of  Dr.  Edwin  N. 
Kent  (Director  of  Extension  Lectures),  Boston,  Mass.  (330  Dartmouth 


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12  THE  DENTAL  DIGEST 

St.)  This  Department  is  prepared  to  furnish  illustrated  lectures  suitable 
to  the  various  needs  of  Mouth  Hygiene  workers  of  the  country.  These 
lectures  with  a  set  of  thirty- two  (32)  slides,  which  have  been  very  care- 
fully selected,  are  supplied  to  the  organizations  or  communities  desiring 
same  at  a  cost  of  $2.50  plus  express  charges  both  ways;  thus  making  it 
ix)ssible  for  Mouth  Hygiene  workers  to  have  at  conmiand  this  kind  of 
service  at  a  minimum  cost. 

It  is  evident  that  the  Association  has  imdertaken  a  great  task  and  is 
prosecuting  it  with  remarkable  vigor.  Raising  the  funds  for  establishing 
and  maintaining  such  work  on  a  national  scale  is  in  itself  a  large  problem. 

One  of  the  most  important  of  all  meetings  of  the  Association  was  held 
in  the  city  of  Washington  on  May  29th  of  this  year.  Many  matters 
which  had  been  pressing  for  attention  were  taken  up  and  measures  adopted 
which  will  strengthen  the  organization  and  extend  its  usefulness. 

The  work  of  the  officers  was  recognized  by  their  reelection. 

The  constitution  and  by-laws  were  amended  to  conform  to  the  laws 
of  the  District  of  Columbia,  and  to  facilitate  the  completion  of  the  incor- 
poration of  The  National  Mouth  Hygiene  Association  as  a  corporation 
not  for  profit. 

The  principal  action  necessary  to  conform  to  law  in  this  connection 
was  the  creation  of  a  Board  of  Trustees — this  Board  to  be  fifteen  in  num- 
ber. The  thirteen  members  of  the  existing  Board  of  Governors,  including 
the  Secretary-Treasurer-General,  were  appointed  to  this  Board  of  Trus- 
tees, the  two  additional  members  being  the  President  of  the  Association 
and  the  Chairman  of  the  Hygiene  &  Education  Committee  of  the  Na- 
tional Dental  Association. 

It  was  also  necessary  to  change  the  formal  title  of  the  Secretary- 
Treasurer  to  "Secretary-Treasurer-General." 

Further  changes  in  the  constitution  were  made  in  order  to  enable  the 
Association  to  carry  out  its  purposes  and  policies;  and  a  preamble  to  the 
constitution  was  adopted  setting  forth  these  purposes  and  policies  as 
given  at  the  outset  of  this  article. 

The  general  financial  problems  of  the  Association  also  came  up  for 
consideration  and  important  action  taken  which  is  expected  in  time,  to 
result  in  larger  and  more  dependable  sources  of  revenue  for  the  local  and 
national  philanthropic  work. 

Annual  dues  of  active  members  were  raised  from  $1.00  to  $2.00  and 
new  methods  adopted  for  the  sale  and  distribution  of  Mogene  Dental 
Products. 

Many  members  of  the  Profession  are,  of  course,  familiar  with  the  fact 
that  Mogene  Dental  Cream  has  for  some  time  been  manufactured  and  dis- 
tributed under  supervision  and  guaranty  of  The  National  Mouth  Hy- 


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A  GREAT  NATIONAL  MOVEMENT  13 

giene  Association,  with  a  binding  guaranty  that  that  portion  of  the  pro- 
ceeds of  sale  receipted  by  the  Association  shall  be  devoted  to  the  Na- 
tional and  local  philanthropic  work  in  the  cause  of  Mouth  Hygiene. 

The  Association  was  led  to  this  action  for  two  reasons;  First,  because 
it  realized  that  here  was  a  logical  and  effective  means  of  increasing  the 
.  fluids  available  for  prosecution  of  its  philanthropic  propaganda.  Second, 
because  it  felt  the  need  of  a  dentifrice  which  it  could  conscientiously 
recommend  to  the  general  public  and  the  dental  profession  as  one  made 
under  the  supervision  and  guarantee  of  The  National  Mouth  Hygiene 
Association. 

Leading  dentists  throughout  the  coxmtry  had  requested  the  Associ- 
ation to  do  this,  for  the  protection  of  the  general  public,  who  are  imable 
to  distinguish  between  reputable  preparations  and  those  containing  or- 
dinary commercial  chalk,  injurious  disinfectants  and  antiseptics  or  other 
unsatisfactory  ingredients. 

The  Association  did  not  undertake  the  actual  distribution  of  Mogene, 
however,  until  careful  study  had  been  given  to  the  subject,  and  investi- 
gation showed  that  it  was  feasible  to  produce  a  dentifrice  of  the  requisite 
quality,  and  to  market  it  successfully. 

It  is  eminently  just  and  fitting  that  the  Association,  which  has  so 
much  encouraged  the  use  of  dentifrices,  should  derive  some  support  from 
their  sale,  instead  of  having  its  philanthropic  efforts  accrue  wholly  to  the 
private  profit  of  established  manufacturers  of  dental  preparations. 
Nothing  imdertaken  by  the  Association,  however,  will  be  antagonistic 
to  the  interests  of  the  manufacturers  of  reputable  dental  preparations — 
on  the  contrary,  the  success  of  The  National  Mouth  Hygiene  movement 
is  greatly  to  their  advantage. 

Commercial  distribution,  of  course,  implies  practical  business  meth- 
ods, and  the  plans  adopted  at  the  meeting  on  May  29th  will,  it  is  felt,  put 
the  distribution  of  Mogene  on  a  soimd  and  thoroughly  satisfactory  basis. 

To  this  end  The  National  Mouth  Hygiene  Association  authorized 
its  officers  to  form  an  organization  to  be  known  as  the  Mogene  Labor- 
atories Company,  which  will  manufacture  Mogene  Dental  Cream  and 
also  Mogene  Tooth  Powder  under  supervision  and  guaranty  of  the  Asso- 
ciation, and  distribute  them  through  regular  commercial  channels  by  the 
most  efficient  methods  of  modem  merchandising. 

In  addition,  the  plan  for  the  distribution  of  Mogene  products  provides 
as  heretofore  for  cooperative  memberships  in  The  National  Mouth  Hy- 
giene Association  or  its  auxiliaries,  available  on  payment  of  One  Dollar 
($1.00)  by  any  person  interested  in  promotion  of  the  work.  In  return  he 
receives  four  full  packages  of  Mogene  Dental  Cream,  which  is  the  regular 
amount  delivered  at  retail  for  one  dollar. 


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14  THE  DENTAL  DIGEST 

This  Cooperative  Package  has  already  shown  great  earning  possibil- 
ities to  the  direct  benefit  of  the  local  auxiliaries,  and  should  develop  tre- 
mendously with  full  realization  of  the  opportunity  by  all  active  members. 

The  Cooperative  Package,  being  distributed  at  the. full  retail  price 
through  the  auxiliaries,  can  be  sold  at  less  ''overhead"  expense  and  ap)- 
proximately  50  cents  out  of  every  dollar  can  be  applied  to  the  funds  avail- 
able for  local  work. 

It  also  is  of  great  assistance  in  soliciting  a  large  Cooperative  Member- 
ship— and  thus  enlisting  more  and  more  persons  in  the  cause  of  Mouth 
Hygiene — because  the  recipient  gets  back  the  full  value  of  his  member- 
ship fee  in  a  dentifrice  of  exceptional  merit,  and  knows  that  he  is  at  the 
same  time  contributing  half  the  purchase  price  to  philanthropic  work. 

Another  important  advantage  of  this  package  is  that  it  helps  the  sale 
of  Mogene  through  the  regular  commercial  channels.  Those  who  are 
thus  once  introduced  to  Mogene  almost  invariably  become  enthusiastic 
users  because  of  its  pleasant  flavor,  entire  freedom  from  grit  or  other 
injurious  ingredients,  and  its  superior  cleansing  properties. 

The  sale  of  Mogene  to  the  great  general  public  will  be  prosecuted  by 
the  most  efficient  methods  of  modern  merchandising.  Especially  in 
cities  where  the  local  work  of  the  Association  is  well  established. 

Mogene  Dental  Cream  and  Tooth  Powder  will  be  advertised  to  the 
public,  and  placed  on  sale  at  reputable  drug  stores  and  department  stores. 
Each  case  of  one  dozen  packages  will  contain  a  participation  certificate 
to  be  held  by  the  dealer  until  collected  by  the  authorized  local  representa- 
tive of  The  National  Mouth  Hygiene  Association  or  the  local  dental 
organization.  Return  of  these  certificates  to  the  Executive  OflSces  of  The 
National  Mouth  Hygiene  Association  will  entitle  the  local  auxiliaries 
to  pro  rata  participation  to  such  funds  as  may  be  set  aside  for  the  pur- 
pose from  the  general  revenue  of  the  Association. 

This  participation  plan  has  been  carefully  worked  out  and  should 
prove  to  be  better  than  the  benefit  checks  formerly  used. 

In  all  matters  relating  to  receipt  and  disbursal  of  funds,  whether  from 
contributions,  sale  of  Mogene  products  or  any  other  source,  the  Associa- 
tion has  made  it  impossible  for  any  of  its  present  or  future  officers  to  ap- 
ply its  revenue  to  any  save  its  recognized  philanthropic  needs. 

It  is  not  only  bound  by  its  incorporation  as  an  association  not  for 
profit,  but  by  a  definite  guaranty — ^which  has  been  widely  published  and 
is  printed  on  the  containers  of  Mogene  products — as  well  as  by  contracts 
with  auxiliaries  and  other  local  organizations. 

To  make  doubly  sure,  the  Association  has  appointed  a  National 
Board  of  Censors  composed  of  the  following  well-known  editors  repre- 
senting dental  and  educational  journals  and  the  public  press: 


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CONDITIONAL  SALE  OF  DENTAL  FIXTURES  AND  FURNITURE        IS 

Dr.  C.  N.  Johnson,  Chicago,  111.,  Editor  of  The  Dental  Review, 

A.  E.  Winship,  Boston,  Mass.,  Editor  of  The  Journal  of  Education. 

Dr.  George  Wood  Clapp,  New  York  City,  Editor  of  The  Dental  Di- 
gest. 

Wm.  C.  Bruce,  Milwaukee,  Wis.,  Editor  of  American  School  Board 
Journal. 

Henry  C.  Williams,  Columbus,  Ohio,  Editor  of  The  Ohio  Teacher. 

Dr.  L.  P.  Bethel,  Columbus,  Ohio,  Editor  of  The  Dental  Summary. 

Frank  B.  Noyes,  Washington,  D.  C,  President,  Associated  Press. 

These  gentlemen  are  empowered  to  examine  the  books  and  records 
of  The  National  Mouth  Hygiene  Association  and  its  subsidiary  organ- 
izations. Should  they  discover  any  evidence  that  the  Association  is  not 
carrying  out  its  obligations  to  the  general  public  and  to  the  dental  pro- 
fession, it  is  their  duty  to  give  such  evidence  widest  publicity  in  the 
journals  which  they  represent. 

The  dental  profession  has  every  reason  to  feel  confident  that  the  new 
plans  for  the  manufacture  and  sale  of  Mogene  products  will  be  of  great 
assistance  in  realizing  the  high  aims  and  purposes  of  The  National  Mouth 
Hygiene  Association. 

In  conclusion,  I  cannot  be  too  emphatic  in  stating  that  The  National 
Mouth  Hygiene  Association  is  a  corporation  not  for  profit,  and  will  con- 
tinue as  the  avowed  servant  of  the  organized  Dental  Profession  and  the 
American  People  in  the  effort  to  advance  their  highest  interests  and  de- 
serve and  secure  their  unqualified  support. 


CONDITIONAL  SALE  OF  DENTAL  FIXTURES  AND 
FURNITURE 

(New  York)  Plaintiff  claims  that  he  purchased  of  defendants  in  April 
1904  furniture  and  fixtures  for  which  he  agreed  to  pay  upwards  of  $900 
in  payments  of  $20  per  month,  and  that  until  the  full  payment  of  the 
purchase  price  the  title  to  the  furniture  was  to  remain  in  the  defendants; 
that  up  to  January,  1907,  he  had  paid  thereon  the  sum  of  $492.  It 
appears  that  in  1904  there  was  some  paper  writing  executed  by  the  par- 
ties; the  plaintiff  claiming  that  it  embodied  the  terms  of  the  conditional 
sale  above  specified.  The  defendants  deny  that  they  sold  the  furniture 
to  the  plaintiff,  asserting  that  they  simply  leased  the  same  to  him,  and 
that  the  monthly  payment  was  not  to  apply  on  a  purchase  price,  but  was 
simply  rental  for  the  use  of  the  furniture,  and  that  the  plaintiff  was  not 
to  become  owner  of  the  furniture  in  any  event.  Plaintiff  defaulted  in  the 
payments  at  this  time  and  defendants  made  an  assignment  of  the  furniture 


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16  THE  DENTAL  DIGEST 

and  fixtures  to  one  Pierce  who  demanded  ix)ssession.  The  plaintiff 
brought  this  action  contending  that  under  section  65  of  the  Personal 
Property  Law  he  was  entitled  to  recover  from  the  defendants  all  the 
moneys  he  paid  to  them  on  the  purchase  price  of  the  furniture;  that  the 
defendants  having  retaken  the  furniture  by  the  assignment  of  the  lease 
to  Pierce,  and  not  having  sold  the  same  by  public  auction,  there  is  due 
plaintiff  from  the  defendants  the  sum  of  $492  and  interest  for  six  years. 

In  the  trial  court  judgment  was  entered  for  defendants  holding  the 
transaction  to  be  merely  a  lease.  On  plaintiff's  appeal  to  the  Supreme 
Court  this  decision  was  reversed,  the  Court  saying: 

"Plaintiff's  right  to  recover  depends  upon  two  important  conditions, 
viz:  First,  that  he  purchased  the  furniture  and  was  to  have  title  when  he 
paid  $946;  and,  second,  that  the  defendants,  or  their  successor  in  interest, 
retook  possession  thereof  under  the  contract  of  sale.  It  was  established 
that  no  sale  of  the  furniture  was  had  by  public  auction  as  provided  by 
statute. 

"The  testimony  on  the  trial  will  warrant  no  other  conclusion  than  that 
the  furniture  was  to  become  the  property  of  the  plaintiff  when  he  paid  the 
full  purchase  price.  Treating  the  moneys  paid  either  as  being  payments 
on  the  purchase  price  or  as  being  rent  for  the  use  of  the  furniture,  the 
transaction  must  be  construed  as  a  conditional  sale,  if  upon  full  payment 
of  the  amount  agreed  to  be  the  purchase  price  title  to  the  furniture  was  to 
vest  in  the  Vendee.''     (Ostrander  v.  Bricka,  154  N.  Y.  S.  786.) 

DENTAL   OFFICE   SCENE   OF   TROUBLE 

(Maine)  A  police  officer  who  entered  the  reception  room  of  a  dentist 
on  a  matter  of  personal  business  does  not,  though  he  thereafter  greatly 
disturbed  the  occupant  and  refused  to  leave  when  ordered,  become  a 
trespasser  ab  initio,  the  case  being  different  from  that  of  an  officer  law- 
fully entering  upon  property  in  execution  of  process,  or  of  a  guest  entering 
an  inn. 

The  Supreme  Court  of  Maine  so  held  in  Nichols  v.  Sonia.  The  facts 
were  as  follows: 

The  defendant  on  the  2d  day  of  December,  1914,  at  Bath,  with  force 
and  arms  broke  and  entered  the  dental  office  of  said  Nichols,  situated  at 
No.  81  Front  Street,  and  thereby  greatly  disturbed  plaintiff  in  the  quiet 
possession  of  his  office,  and  then  and  there  remained  after  he  had  been 
ordered  to  leave,  and  vacate  the  office  by  the  plaintiff.  Defendant  used 
insulting  language,  threatened  violence,  and  used  slanderous  words  while 
he  remained  in  the  office. 

The  evidence  disclosed  that  plaintiff,  shortly  before  half  past  10 
o'clock  in  the  evening  of  the  day  alleged,  was  in  the  operating  room  of 


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CONDITIONAL  SALE  OF  DENTAL  FIXTURES  AND  FURNITURE        17 

the  suite  of  rooms  occupied  by  him  as  an  office;  that  the  rooms  were 
lighted;  that  plaintiff  was  there  in  the  transaction  of  his  business;  that  at 
the  hour  last  named  the  defendant,  a  policeman  of  the  city  of  Bath, 
opened  in  the  usual  manner  the  door  giving  entrance  to  the  suite  of  plain- 
tiff, and  entered  one  of  the  rooms,  the  door  being  latched  but  not  locked. 
In  this  room  was  the  wife  of  plaintiff.  The  defendant  then  made  in- 
quiries as  to  the  future  disposition  of  a  cause  in  court  which  had  recently 
been  decided  in  his  favor  against  plaintiff,  and,  upon  receiving  a  reply, 
indulged  in  profane  language,  opprobrious  epithets,  and  charges  of  per- 
jury, declining  to  leave  the  apartment  when  ordered  to  do  so  by  plaintiff. 
Suit  was  brought  charging  the  defendant  with  trespass.  The  lower  court 
entered  a  nonsuit  and  an  appeal  was  taken  to  the  Supreme  Court  where 
the  nonsuit  was  affirmed.  The  Court  in  disposing  of  the  case  said,  "The 
contention  of  the  plaintiff  that  the  defendant  by  his  conduct  became  a 
trespasser  ab  initio^  cannot  be  entertained.  Defendant  did  not  enter  in 
the  discharge  of  any  of  his  duties  as  policeman.  His  entrance  was  not 
by  authority  of  law,  as  is  the  case  of  an  officer  lawfully  entering  upon 
property  in  execution  of  legal  process  or  of  a  guest  entering  an  inn.  The 
office  was  alight,  the  hour  not  unreasonable,  the  place  improper,  nor  the  in- 
quiry impertinent.  His  errand  was  one  of  business,  and  we  must  find  upon 
the  evidence  that,  if  not  an  invitee,  he  was  in  by  license  of  the  occupant. 

The  exceptions  to  the  order  of  nonsuit  must  therefore  be  overruled. 

Exceptions  overruled.     (Nichols  v.  Sonia,  95  A.  209.) 

DENTIST  ENGAGED  IN   SALE   OF  PROPRIETARY  MEDICINES 

(New  York).  The  New  York  Supreme  Court  in  Kilmer  v.  Dr.  Kil- 
mer &  Company  has  held  that  an  injunction  will  be  allowed  to  restrain 
a  partner  in  a  patent  medicine  business  from  receiving  and  opening  any 
mail  addressed  in  a  manner  from  which  it  appeared  that  the  communica- 
tion was  intended  for  the  other  member  of  the  firm  personally  or  pro- 
fessionally. 

Prior  to  1892  Dr.  Andral  Kilmer  a  dentist  and  Jonas  M.  Kilmer  were 
engaged  as  copartners  in  the  manufacture  and  sale  of  patent  medicines. 
In  1892  Andral  sold  the  business  to  his  brother  for  $40,000.  The  sale 
included  all  trade  marks,  copyrights,  labels,  wrappers,  circulars,  pam- 
phlets, etc.  Needless  to  mention  the  good  will  of  the  business  was  also 
transferred.  Andral  was  to  receive  25  per  cent,  of  the  profits  of  the 
business. 

In  1901,  Jonas  M.  Kilmer  sold  the  business  to  his  son  Willis  Kilmer 
who  after  engaging  in  the  manufacture  of  the  patent  remedies  until  1909 
sold  the  business  to  a  corporation.  The  corix)ration  adopted  the  name  of 
the  Dr.  Kilmer  Company. 


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18  THE  DENTAL  DIGEST 

Dr.  Andral  Kilmer  brought  this  suit  against  the  corporation  to  en- 
join it  from  using  the  prefix  ''Dr/'  or  from  using  his  picture  and  receiving 
mail  addressed  to  Dr.  Kilmer.  His  claim  was  that  the  corporation 
wished  the  general  public  to  believe  that  he  was  still  connected  with  it. 
Kilmer  asked  the  court  to  enjoin  the  company  from  receiving  and  opening 
mail  addressed  to  Dr.  Kilmer  or  even  to  the  Dr.  Kilmer  Company.  The 
court  granted  the  injunction  saying  that  defendant  knew,  or  ought  to 
know,  that  a  letter  addressed  to  plaintiff  with  the  prefix  ''Doctor"  or 
with  the  word  ''Personal"  on  the  envelope  was  for  him.  The  defendant 
knew  or  ought  to  have  known,  that  when  a  person  writes  to  any  address 
containing  the  name  or  designation  of  a  professional  man  that  letter  con- 
tains a  private  and  confidential  communication  not  intended  to  pass 
through  hands  who  have  no  right  to  know  its  contents. 

The  defendant  had  the  right  to  manufacture  and  distribute  for  sale, 
and  advertise  the  same,  all  of  the  medicines  originated  by  Dr.  S.  Andral 
Kilmer  and  transferred  to  Jonas  M.  Kilmer;  it  had  a  right  to  designate 
them  as  so  originated  and  compounded  by  Dr.  Kilmer,  but  it  has  no  right 
to  so  use  the  plaintiff's  name  as  to  lead  the  public  to  believe  that  he  was 
still  responsible,  by  reason  of  active  supervision,  for  the  contents  of  a 
bottle  covered  in  part  by  his  portrait  and  name.  (Kilmer  v.  Dr.  Kilmer 
Co.,  IS4  N.  Y.  S.  982.) 

WHAT  I  LIKE  ABOUT  MY  DENTIST 
By  C.  D.  B.,  Plaixfield,  N.  J. 

Thinking  that  the  results  might  prove  interesting  to  the  readers  of 
The  Dental  Digest,  I  recently  asked  a  number  of  women  in  my  home 
town  what  they  liked  about  their  dentists.  Their  replies  I  append  below 
vjrbatim — they  speak  for  themselves. 

"He  doesn't  put  his  whole  fist  in  my  mouth." 

"He  stops  the  minute  he  sees  he's  hurting  me." 

"He  arranges  his  appointments  so  systematically  that  I  don't  have  to 
wait  long  in  the  ante-room." 

"His  waiting  room  is  so  cheerful  and  cosy  that  I  don't  mind  waiting." 

"He  doesn't  keep  you  in  the  chair  until  you  never  want  to  see  him  or 
his  office  again.    He  believes  in  shorter  appointments  and  so  do  I." 

"He's  a  careful  workman,  he  never  blunders." 

"He's  a  good  conversationalist.  He  helps  me  to  forget  I'm  having 
my  teeth  fixed." 

Some  of  these  "reasons  why"  may  seem  hardly  important  but  they're 
all  actual  "women's  reasons"  and  perhaps  they'll  carry  just  a  suggestion 
for  better  service  to  someone. 


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(AINE/y^VILDING 


''Nothing  but  the  very  best  of  instru^ 
merits  and  materials  can  give  your  ability 
the  assistance  it  deserves."— Se/ec^ed. 

THE  BUSINESS  SmE  OF  PROPHYLACTIC  AND 
RESTORATIVE  PRACTICE 

By  W.  F.  Spies,  D.D.S.,  and  George  Wood  Clapp,  D.D.S.,  New  York 

FIRST  PAPER 

If  a  prophylactic  and  restorative  practice  is  financially  profitable,  it  en- 
ables the  dentist  to  render  patients  important  services  and  to  receive 
proper  remuneration  therefor.  If  it  is  not  profitable,  the  dentist  will  be 
unable  to  apply  to  such  service  a  high  degree  of  skill,  patients  will  be  de- 
prived of  benefits  they  should  enjoy  and  the  dentist  will  not  receive  proper 
remuneration  for  his  skill  and  labor. 

Few  dental  practices  are  financially  successful  save  as  the  result  of 
careful  attention  to  their  business  side.  Some  practices  make  money  be- 
cause the  fees  for  some  kinds  of  service  are  higher  than  is  justified  by  the 
costs  of  those  operations,  which  is  unjust  to  the  patients  who  receive  those 
particular  forms  of  service.  In  practices  where  fees  are  fixed  in  this  way, 
the  fees  for  other  forms  of  seI^dce  (such  as  consultations,  treatments,  etc.) 
are  often  disproportionately  low,  which  works  injustice  to  the  patients 
who  paid  the  high  fees  and  to  the  dentist. 

It  will  be  much  better  for  all  concerned  when  fees  for  the  several 
forms  of  dental  service  can  be  determined  with  justice  to  all  patients  and 
to  the  dentist,  so  that  no  one  pays  more  than  he  should  and  the  dentist 
is  always  sure  of  adequate  payment  for  his  labors.  The  object  of  this 
series  of  articles  is  to  show  how  each  dentist  may  learn  what  each  form  of 
service  costs  him  and  what  are  the  minimum  fees  which  are  fair  to  his  pa- 
tients and  himself. 

We  are  unable  to  fix  such  fees  for  any  individual  dentist,  but  we  have 
kept  such  detailed  records  and  have  access  to  such  office  cost  reports  from 
other  dental  practices  that  we  are  able  to  state  approximately  what  many 
operations  cost  dentists  in  practices  where  the  gross  receipts  vary  from 
$1,500  to  $5 ,000.  We  offer  this  information  in  the  belief  that  this  form  of 
knowledge  affords  the  only  intelligent  basis  for  determining  minimum 
fees,  and  in  the  hopes  that  it  may  inspire  other  dentists  to  develop  exact 
information  concerning  their  own  practices. 


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20  THE  DENTAL  DIGEST 

ESTIMATING  OFFICE  COSTS 

College  costs $i,ooo 

Three  years'  time  at  $500 1,500 

$2,500 

Reception  Room  Investment 102 

Operating  Room  Investment 820 

Laboratory  Investment 130 

$3,552 
Operating  Costs: 

Depreciation  (10%  of  first  cost  of  office  investment)   .  $105 
Refunding  investment  (5%  annually  of  total  invest- 
ment)    175 

Rent 334 

Heat 12 

Light 45 

Phone 12 

Laundry 26 

Assistant (?) 

Publicity  (cards,  tickets,  etc.) 10 

Express  and  postage 12 

Taxes (?) 

Insurance 5 

Magazines  and  books 10 

Society  expenses 15 

Laboratory  bills 100 

Supplies  other  than  precious  metals 160 

Precious  metals 140 

$1,161 

Total  practice  annually $2,500 

Fig.  I. — Illustration  of  a  chart  which  has  been  found  useful  in  determining  office  costs. 
It  is  here  shown  as  filled  in  for  a  well  conducted  practice  with  gross  receipts  of  $2,500 
annually.     This  is  believed  to  be  about  the  average  size  of  practice. 


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BUSINESS  SIDE  OF  PROPHYLACTIC  AND  RESTORATIVE  PRACTICE       21 

THE  ELEMENTS   OF  COSTS 

The  cost  of  any  operation  to  any  dentist  can  be  determined  only  by 
learning  what  it  costs  him  to  conduct  his  office  during  each  income-hour 
and  then  multiplying  that  cost  by  the  hours  or  fractions  thereof  involved 
in  the  operation.  If  precious  metals  or  teeth  were  employed,  their  value 
should  be  added  to  the  product  of  the  hour-cost  and  the  time. 

The  income-hour  cost  can  be  easily  determined  with  approximate  ac- 
curacy. The  items  of  cost  in  fitting  the  dentist  for  his  special  vocation, 
and  of  establishing,  equipping  and  conducting  the  office  should  be  tabu- 
lated. The  form  illustrated  in  Figure  i  has  been  extensively  used  but  may 
be  modified  as  desired. 

OFFICE  HOURS   AND   INCOME  HOURS 

The  hours  which  the  dentist  spends  at  his  office  may  be  conveniently 
referred  to  as  office  hours.  It  is  believed  that  under  ordinary  conditions 
these  hours  should  number  about  2,000  per  year.  Dr.  W.  J.  Holroyd  sub- 
mits the  following  table  showing  how  the  number  is  determined.  This 
number  of  hours  permits  proper  attention  to  business  and  to  the  study  and 
recreation  which  are  so  necessary  to  mental  advancement  and  physical 
health: 

365  days 
52  Sundays  off 


313 

6  holidays  before  mentioned 


307 
28  days'  vacation 


279 
21  days  for  dental  meetings  at  different  parts  of  the  year 


258  or  37  weeks  per  year,  less  ^  day  per  week,  making 
i8i  days  subtracted 

239^^ 
Multiplied  by  8  hours  in  office 

19 1 6*  office  hours  per  year 

Not  all  of  the  office  hours  can  be  employed  in  service  for  which  full 
fees  can  be  charged,  and  some  time  will  be  so  employed  that  no  fee  can 
be  charged.     Time  is  usually  lost  in  greeting  or  dismissing  patients,  in 

•Very  few  dentists  can  take  one  half  day  off  every  week  in  the  year  and  28  days'  vacation 
and  this  19 16  hours  will  doubtless  extend  to  2,000  hours. 


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22  THE  DENTAL  DIGEST 

visits,  by  friends  or  business  people,  in  making  appointments,  in  telephone 
calls,  in  charity  work,  and  in  other  ways,  leaving  only  about  4  hours  a 
day  actual  income  hours.  The  income-hours  afford  the  only  exact  and 
satisfactory  basis  for  determining  costs  and  estimating  fees. 

Experience  seems  to  show  that  of  2,000  office  hours  per  year  not  more 
than  1,000  will  be  income-producing  hours  under  even  the  most  favorable 
conditions,  and  in  many  practices  the  number  will  be  much  less.  The 
estimates  of  costs  which  follow  are  based  on  1,000  income-hours  per  year 
in  the  belief  that  this  number  will  not  often  be  exceeded. 

CLASSES   OF   PRACTICE 

In  order  to  render  our  time  records  valuable  to  dentists  in  determining 
their  own  operation-costs  it  has  been  necessary  to  divide  practices  into 
classes  to  determine  the  income-hour  cost  for  each  class,  and  then  to  mul- 
tiply our  time  records  by  the  income-hour  costs. 

Class  I  practices  of  less  than  $2,000  gross  receipts  annually. 

Class  II  ptactices  of  $2,000-2,999  gross  receipts  annually. 

Class  III  practices  of  $3,000-3,999  gross  receipts  annually. 

Class  IV  practices  of  $4,000-4,999  gross  receipts  annually. 

Class  V  practices  of  $5,000-5,999  gross  receipts  annually. 

It  will  be  found  easy  to  remember  the  classes  if  it  is  observed  that  the 
class  number  is  the  same  as  the  first  figure  of  the  total  receipts. 
Practices  will  hereafter  be  referred  to  by  these  numbers. 
{This  article  will  be  continued  next  month) 


HOW  TO  MAKE  AND  SAVE  A  COMPETENCY  FOR  OLD  AGE 

I  see  in  your  November  number,  an  article  entitled  '^  A  Compensation 
For  Old  Age,"  that  has  induced  me  to  write  these  lines,  not  to  find  fault 
nor  to  criticize,  for  in  the  main  I  agree  with  the  writer,  and  as  I  have  been 
a  practitioner  of  dentistry  for  over  thirty  years,  I  think  I  can  tell  the 
beginner  a  lot. 

This  is  an  age  that  realizes  the  power  of  Corporation  or  Cooperation, 
and  to  succeed  in  our  profession  to  the  extent  of  gaining  a  competency 
these  principles  have  to  be  applied — so  let  us  get  to  work  and  form  a  cor- 
poration of  the  following  Stock  Holders: — 

ist.  Mr,  Talent.  He  is  hard  to  describe,  but  most  anyone  can  tell 
him  after  seeing  him  design  and  execute  some  appliance,  he  is  the  first 
and  most  essential  party  and  do  not  attempt  to  run  business  without  him. 

2nd.  Mr.  Like.  This  does  not  mean  that  you  have  to  be  dead  in 
love  with  every  detail  of  the  profession,  but  it  does  mean  that  you  are  to 


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HOW  TO  MAKB  AND  SAVE  A  COMPETENCY  FOR  OLD  AGE         23 

look  upon  it  with  pride  and  as  a  choice  and  not  as  a  compulsion.  It 
means  that  you  are  to  enjoy  seeing  things  work,  and  that  you  really  feel 
as  though  you  are  doing  something  worth  while.  Remember  that  there 
is  no  business  that  does  not  have  its  objectionable  feature. 

3rd.  Mr.  Qualify.  Be  certain  that  his  name  is  what  he  says  and 
that  he  keeps,  day  by  day,  busy,  to  keep  up  with  the  times  and  if  he 
changes  his  name,  see  that  it  be  to  Qualifying^  that  means  continually 
at  it. 

4th.  Mr,  Slick.  That  means  keep  at  it.  Yes,  everlastingly  at  it, 
(but  this  does  not  mean  that  you  are  to  take  no  rest).  The  public  like 
to  patronize  a  busy  man — ^be  occupied  whether  you  are  or  not,  profes- 
sionally, you  see? 

Sth.  Mr.  Equip.  Supply  yourself  with  a  good  outfit,  especially 
instruments  and  keep  a  sharp  lookout  for  the  new  things  that  come 
along  but  be  careful  not  to  invest  in  everything  advertised  and  in  noth- 
ing until  you  are  confident  it  will  prove  what  you  want. 

Do  not  throw  away  your  old  instruments  entirely  to  use  the  new,  but 
get  such  of  the  new  as  you  can  use  and  appear  well.  I  have  some  of 
Frank  Arnold's  make  of  instruments,  especially  forceps,  that  I  have  had 
from  the  beginning  and  they  are  not  plated  (as  that  was  before  the  day  of 
plating  everything),  but  for  service,  for  real  adaptableness,  there  has  never 
been  better  made.  While  I  have  scores  of  other  forceps,  I  frequently 
in  difficult  cases  reach  for  the  Old  that  I  kno^  are  tried  and  true — instru- 
ments are  like  friends.  It  is  well  enough  to  make  new  friends  and  try 
them,  but  do  not  throw  off  the  old  tried  and  true  ones,  because  they  are 
not  nickel-plated. 

6th.  Mr.  Fee.  Charge  reasonable  but  compensating  fees  and  make 
no  apologies  for  so  doing. 

7th.  Mr.  Appearance.  Keep  your  office  as  well  as  yourself  and  in- 
struments, sanitary,  clean,  attractive,  but  keep  an  eye  on  the  expendi- 
tures for  same. 

Sth.  Mr.  Relaxation.  Take  time  for  recreation  and  especially  the 
one  day  in  the  week,  the  Sabbath — God  knew  what  was  best  for  man 
physically  as  well  as  spiritually,  and  he  says  "Rest  on  the  Sabbath." 
I  have  tried  it  and  I  know  that  it  is  true.  Every  few  years  take  a  week  or 
ten  days  off  and  go  back  to  the  college  from  which  you  were  graduated — 
visit  the  old  members  of  your  class  if  they  are  on  your  way,  and  note  how 
they  are  getting  on  and  you  will  find  that  you  will  learn  and  be  improved 
by  seeing  how  some  have  succeeded  better  than  you,  and  you  will  feel  a 
sense  of  pride  and  encouragement  in  seeing  how  much  better  you  have 
done  than  some  others. 

If  you  live  in  a  country  town,  go  to  the  city  for  a  vacation,  now  and 


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24  THE  DENTAL  DIGEST 

then,  and  keep  your  eyes  and  ears  open  to  all  that  is  to  be  seen  and 
heard.  When  you  get  there,  get  a  good  nice  clean,  respectable  place  to 
stay;  this  does  not  mean  that  you  are  to  go  to  the  swellest  hotel  there  and 
fill  your  stomach  full  of  things  that  you  are  not  used  to  eating,  and  make 
not  only  a  hog  of  yourself  but  a  fool  as  well.     Leave  off  drinks  and  dopes. 

If  you  are  located  in  the  city  go  to  the  country  for  this  vacation. 
Go  to  the  mountains  where  Him,  Bob,  Mam,  Sal  and  Beta  live  and  see 
how  they  spend  life.  Get  a  good  mountain  breeze,  and  listen  to  the 
trickling  streams.  Do  not  fail  to  take  your  fishing  tackle  along,  there  is 
nothing  that  will  thrill  you  like  the  bite  of  a  trout  or  black  bass.  I  went 
out  the  other  day  and  strung  up  fifteen  black  bass  (beauties  they  were). 

My  boy  about  eleven  years  old  went  with  me  and  he  caught  two  and 
got  quite  a  number  of  strikes  that  he  failed  to  land  and  the  other  night 
he  said  to  me  "Father,  I  can  just  feel  those  fish  biting  yet,  can  you?'' 
Yes,  and  hope  to  all  winter.     Try  it,  but  do  not  spend  too  much  time. 

9th.  Mr.  Economy,  Be  economical  and  I  do  not  mean  by  that  to 
be  stingy  and  stint  yourself  and  family,  but  keep  well  within  your  means 
— have  good,  well  cooked,  wholesome  food  for  yourself  and  family,  for  it 
is  more  economical,  to  say  the  least,  than  doctor's  bills  and  drug  expenses. 
Wear,  and  let  your  family  wear  good,  neat,  clean  clothes,  but  in  all  things 
be  not  a  spendthrift  for  this  will  not  only  take  your  money  but  teach  your 
family  bad  habits. 

Do  not  try  to  keep  up  with  the  fellow  who  has  inherited  a  lot  of  money 
and  has  nothing  to  do  but  fool  it  away.  It  is  well  enough  to  have  him 
as  a  patient,  but  not  as  a  chum. 

Refrain  from  useless,  hurtful  and  expensive  habits,  among  which  are 
drinking,  doping  and  the  use  of  tobacco.  I  will  specially  mention  only 
the  last  named,  (but  many  others  bear  a  similar  solution)  the  use  of  to- 
bacco does  not  help  your  appearance,  but  quite  the  reverse.  It  does  not 
help  your  physical  condition,  but  in  many  if  not  in  all  instances,  it  is 
hurtful.  The  pleasure,  if  any,  is  more  than  offset  by  the  displeasure  in  not 
being  able  to  indulge  many  times.  How  about  the  expense  of  it?  I  be- 
gan the  use  of  tobacco  by  the  advice  of  a  physician,  about  the  time  I  did 
dentistry,  and  after  using  it  a  while  I  took  an  inventory  of  myself  on  that 
line  and  I  soon  saw  that  it  did  me  no  good,  but  harm.  It  did  not  make 
me  look  any  better,  nor  did  it  make  me  smell  any  better  either. 

In  that  inventory  I  figured  that  at  the  present  rate,  (about  7  cigars  a 
day)  it  would,  within  thirty  years  cost  me  enough  to  buy  a  nice  home. 

I  quit  and  to-day  I  am  living,  fully  paid  for,  in  a  nice  home  saved  in 
this  way,  (just  make  the  calculation  and  it  will  amaze  you)  and  I  ex- 
pected also  to  have  some  boys  and  I  did  not  want  to  set  them  that  kind 
of  an  example  and  so  you  see  that  I  will  not  only  be  benefited,  but  future 


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HOW  TO  MAKE  AND  SAVE  A  COMPETENCY  FOR  OLD  AGE  25 

generations  also.  If  you  are  already  a  user  of  it,  you  will  say  *'  that  you 
can  not  quit  it,"  and  I  agree  with  you  that  it  is  hard  to  do,  but  the  only 
way  is  to  quit  and  stay  quit — yes  quit,  and  in  twenty  years  or  less  you  will 
have  saved  for  yourself  and  family,  a  nice  home,  and  just  think,  too,  of 
the  offensive  odor  of  tobacco  you  have  saved  your  patients  from  inhaling. 

loth.  Mr.  Literature.  You  should  keep  some  good  literature  in 
your  office  for  your  waiting  patients  and  be  certain  to  read  up  yourself 
on  all  current  events.  A  good  daily  paper  and  at  least  two  good  weekly 
periodicals  should  be  read  and  at  handball  JSe-Jti^e/-^  j.    ;* 

nth.  Mr.  Congenial..  Ypu  sliQulclJefirn  n©t.6nly  how  to  handle  pa- 
tients while  in  the  ch^fr^  but  how-to  iiieci  ihtem^rjdce^p^ci^lly-hqw  to  dis- 
miss them;  all  this  requires  kjiackltud,sjtiidy  of  human  nature  as  you  can 
not  do  with  all  just  alike.      '  :  »'    :»:    :  /A  -  •.     ^-  ,; 

1 2th.  Mr.  Personality.  You  should  be  yourself  and  not  imitative 
nor  affected.  Do  not  expect  to  please  everybody  for  Christ  did  not  do 
that  but  stand  for  your  rights  and  principles  on  all  lines  and  be  able  to 
give  reason  for  the  faith  within  you. 

13th.  Mr.  Financier  or  Mr.  Investor.  Now,  I  hope  you  are  not 
superstitious  about  the  number  thirteen  and  if  you  are  you  may  add 
other  Stock  Holders,  but  see  that  you  have  at  least  these  named.  Do 
not  expect  this  last  named  party  to  be  so  perfect  as  to  make  no  mistakes 
for  he  will  make  them  by  doing  things  he  ought  not  do  and  worse,  by  not 
doing  things  he  should  do,  but  do  not  attempt  nor  expect  to  succeed  so  as 
to  reach  the  point  set  out  without  this  last  named  partner. 

I  look  all  around  me  and  I  see  monuments  to  my  folly  by  doing  the 
wrong  thing  as  well  as  for  not  doing  the  right  thing. 

Remember  that  there  is  but  one  kind  of  a  man  that  makes  no  mis- 
takes and  that  is  A  dead  man. 

This  Stock  Holder  is  hard  to  describe  because  times,  conditions  and 
places  vary  so  much.  A  very  great  deal  depends  upon  how  you  invest 
your  money,  because  years  of  earnings  can  be  swept  from  you  in  the 
twinkling  of  an  eye.  No  one  can  tell  you  how  to  do  this  for  as  above  said, 
times,  condition  and  places  are  not  all  alike.  But  for  the  past  twenty 
years  investments  in  real  estate  have  been  the  safest  and  best  in  all  sec- 
tions of  the  country,  and  is  getting  better  in  many  sections  and  especially 
in  the  South.  Good  farming,  grazing  and  timber  lands  have  been  and 
always  will  be  the  best  on  this  line.  Shy  at  mortar  and  brick  or  tenant 
property,  as  they  are  too  much  trouble  and  expense  to  look  after.  Run 
from  Boom  Town  property,  do  not  listen  to  the  Boom  promoter  when  he 
tells  you  that  such  and  such  a  lot,  now  covered  with  brush  and  sedge 
grass,  will  eventually  bring  thousands  of  dollars,  for  I  tell  you  from 
personal  experience  that  most  of  them  will  not  bring  the  taxes,  eventually. 


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26  THE  DENTAL  DIGEST 

Fear  Mining  Stock  as  you  would  satan  and  in  fact  all  kinds  of  stock  for 
several  reasons!  One  is,  that  they  contain  too  much  water  and  what  is 
not  water,  is  wind.  Remember  the  earth's  surface  is  about  three  fourths 
water  and  too  plentiful  to  pay  such  a  high  price  for  it. 

Loans  on  lands  secured  by  deeds  of  trust  have  always  been  good  and 
always  will  be  if  made  on  good  titles  and  not  over  half  the  selling  price  on 
forced  sales.  This  will  yield  6  per  cent,  and  good  as  gold.  I  could  loan 
thousands  aud.tj^ousand&atd^llaj's  thus  secured. 

Many  thi^^-'^ojHeJ  fe  said  abbut  financiering,  but  time  and  space  arc 


.  ...HQt.sii^iant.her^.:^.:  ";  :      .-.  -/i 
V    I   :JSi>.^sU5ilb'iJisfe- Stock  Hoid:^!- 


dfefs-'Wofk  fo^gether  continuously  and  har- 
monio,u§ly,j^oiii  augKj  to  hne  ^le:tctlay  ty^'a;competency  in  tangible  prop- 
ert^yJfo.-yleltEyou-'a.dufiiacnt'incoSYic  16  s\jtpp\y  your  needs,  say  $30,000 
and  that  even  4  per  cent,  will  yield  you  $1,200  a  year  or  $100  a  month. 

Be  not  discouraged  if  you  have  set  your  competency  at  $30,000  in  30 
years  if  the  first  years  do  not  yield  the  thirtieth  of  this  or  $1,000  for  the 
first  $1,000  is  the  hardest  to  get  and  remember  that  what  you  save  should 
be  put  to  work  to  help  make  a  part  of  the  next  $1 ,000  and  so  you  will 
see  that  when  you  have  saved  $1,000  and  put  it  to  work  that  it  pays  $50 
a  year  on  the  next  at  5  per  cent,  interest  and  so  on. 

The  above  results  can  be  reached  as  I  can  testify  from  experience,  but 
I  want  to  say  that  it  takes  **get  up''  and  "hustle,"  yes  and  plenty  of  it, 
for  this  is  no  small  matter,  it  is  a  man's  job,  to  reach  this  point  and  to  de- 
fray the  heavy  expense  of  keeping  and  educating  a  family.  It  takes  a 
head  and  back-bone  and  everlastingly  sticking  to  it — you  will  have  to 
pay  the  price. 

I  might  speak  further  about  a  Competency  in  Old  Age  in  the  way  of 
Boys,  as  I  have  four  of  them.  It  is  a  very  poor  boy,  when  well  cared  for 
and  educated,  that  is  not  worth  $30,000  to  his  parents  or  that  could  not 
nor  would  not  take  care  of  faithful  parents  in  old  age,  so  if  mine  pan  out 
all  right  they  will  be  worth  $120,000  on  a  cash  basis  to  say  nothing  on 
other  lines. 

The  above  is  rather  long,  but  it  is  not  imaginary  nor  speculative,  but 
knowledge  from  actual  experience. 

Now,  you  imagine  that  I  am  an  old  wornout  man,  but  you  are  er  • 
tirely  mistaken,  for  I  h^.ve  laid  up  a  Competency  in  strength  and  youth- 
fulness  by  observing  the  Laws  of  Nature  and  stouter  to-day  than  when  25 
years  of  age.  Lay  up  a  competency  in  strength  and  youthfulness  by 
right  living  and  not  by  idleness  and  laziness.  Very  few  kill  themselves 
by  work,  but  multiplied  thousands  do  by  dissipation,  anc  they  say,  I  am 
working  myself  to  death. 

N.  W.  D. 


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HOW  CAN  HB  BETTER  CONDITIONS?  27 


HOW  CAN  HE  BETTER  CONDITIONS? 

Editor  Dental  Digest: 

I  take  the  liberty  of  writing  you  about  a  subject  that  is  of  vital  im- 
portance to  me,  and  which  gives  me  no  little  trouble. 

The  dental  fees  in  our  little  city  are  the  lowest  in  the  state,  and  if  you 
will  pardon  me  for  going  into  details  which  are  excusable  when  writing 
about  a  subject  of  this  kind,  I  will  explain  the  situation  as  follows: 

H is  a  town  of  about  7,000  population  and  is  surrounded  by  a  fine 

back  country.    There  are  three  dentists  here  including  myself.     Dr. 

A has  been  here  in  active  practice  for  thirty  years,  and  Dr.  B.  for 

about  18  years.  Dr.  A.  is  about  50  years  old  and  related  to  a  number  of 
people  in  the  country.  He  had  the  fees  down  so  low  that  a  man  can 
hardly  make  a  decent  living,  unless  he  is  a  very  fast  operator  and  has  a 
wonderful  constitution;  all  of  these  this  man  possesses.  Our  fees  are 
as  follows: 

Cleaning  teeth $  .50 

Amalgams 50 

Gold  fillings i .  00  up  to  $2 .  cxj  and  then  a  gold  crown 

Gold  crowns 2.50  to  $4.00 

Vulcanite  dentures 8.00  to  10.00 

Filling  with  Amalgan  and  treatment  1.00 

Porcelain  crown 2.00 

Extraction 25 

And  all  other  operations  accordingly. 

I  have  been  here  for  nine  years,  and  during  that  time  I  have  tried  to 
get  Dr.  A.  to  raise  the  fees,  and  he  says  that  the  people  will  not  pay  them. 
He  gives  very  long  credit  and  does  not  try  to  collect,  and  this  is  a  great 
drawback  to  one  who  wants  to  run  this  part  of  the  business  in  a  better 
way.  Dr.  B.  I  think,  would  be  willing  to  raise  the  fees  if  A  would  agree, 
but  we  have  to  hold  back  on  account  of  the  latter.  This  old  fellow  has 
the  most  wonderful  grip  on  the  people  that  I  ever  saw,  and  they  will  be- 
lieve anything  he  says.  He  guarantees  all  his  work,  and  no  matter  how 
long  it  has  held  good,  he  will  put  it  back  free  of  charge.  Until  three 
years  ago  he  did  excellent  work,  considering  his  immense  patronage.  He 
works  from  six  a.  m.  to  eight  p.  m.,  and  his  long  hours  without  rest,  are  tell- 
ing on  him.  He  is  growing  very  nervous  and  suffers  with  terrible  head- 
aches in  the  summer,  which  causes  him  to  be  more  irritable,  to  the  loss 
of  a  patient  now  and  then. 

If  he  had  to  sweat  over  making  a  bridge  a  few  times,  he  would  charge 
more  for  his  work.  He  takes  an  impression  of  the  abutments,  and  when 
the  bridge  comes  he  grinds  the  teeth  to  fit  the  bridge.     He  keeps  single 


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28  THB  DENTAL  DIGEST 

gold  crowns  in  stock  and  has  all  his  plate-work  done.  This  way  allows 
him  to  work  all  the  time  at  the  chair  at  small  fees,  and  being  such  a  fast  op- 
erator, his  cheap  fees  will  amount  to  something.  And  up  to  two  years  ago 
he  worked  all  day  Sunday;  but  now  'tis  only  half  that  day  that  he  takes. 

I  have  written  in  detail  about  the  above  man  to  give  you  an  insight 
into  his  methods.  I  have  come  to  the  conclusion  that  only  death  will 
remedy  things,  and  if  it  ever  does  bring  relief  it  will  bring  it  here.  This 
man's  way  of  doing  is  the  talk  of  the  fraternity  of  this  state,  and  if  you 
have  ever  seen  a  constitution  of  steel,  this  man  has  it. 

I  have  read  of  the  successful  sanitary  dental  office,  but  it  is  not  worth 
three  cents  here  where  people  would  wade  through  filth  to  get  cheap 
work.  I  have  read  of  the  man  who  was  complaining  all  the  time  when 
he  should  work  that  much  faster.  But  what  is  there  in  all  this,  if,  after 
the  day  is  done,  you  have  nothing  for  your  labors,  save  a  tired  body  and 
are  sick  at  heart.    There  is  plenty  of  work  for  us  three,  but  nothing  in  it. 

Now  Doctor,  if  you  will  pardon  a  few  remarks  as  to  myself,  that  you 
may  be  more  ably  informed  as  to  the  situation  here,  I  will  give  them.  I 
worked  my  way  through  one  of  the  first  colleges  in  this  state,  that  I  might 
prepare  myself  to  more  intelligently  practise  dentistry.  I  have  been  in 
this  noble  profession  long  enough  to  peep  over  the  starvation  i>eriod — 
nine  years.  You  know  where  fees  are  good,  and  a  young  man  is  not 
getting  much  to  do,  they  will  bridge  him  over;  but  when  they  are  low  it 
takes  many  operations  to  make  something.  I  have  sufficient  confidence 
in  myself,  not  to  overvalue  my  ability,  for  none  of  us  ever  get  to  that 
stage  where  we  cannot  learn  something.  I  can  say  that  I  am  a  dentist 
who  does  good  work,  keeps  abreast  with  the  modem  methods,  a  member 
of  the  dental  society,  and  a  slow  operator,  but  thorough. 

I  hope  you  will  pardon  me  for  taking  so  much  of  your  valuable  time; 
but  if  you  ever  did  go  into  Macedonia  to  help  a  fellow,  I  need  your 
assistance  to  see  if  you  can  tell  me  the  best  way  to  better  conditions  here. 

E.  S.  G. 

AVOID  APPETIZERS 

One  group  of  students  had  a  good  dinner  without  alcoholics,  a 
couple  of  hours  later,  digestion  was  found  well  advanced;  another 
group,  the  same  dinner,  preceded  by  a  cocktail,  digestive  processes  im- 
perfect, owing  to  the  presence  of  alcohol. 

Serious  and  permanent  interference  with  digestion  was  proved  by 
these  experiments.  The  appetizer,  so  called,  is  in  reality  a  devitalizer, 
destructive  of  normal  processes  of  the  digestive  apparatus  and  of  the 
mental  powers  in  direct  proportion  to  the  frequency  with  which  it  is 
taken. — Experiments  at  Yale, 


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A  REPLY  TO  M.  F.  R.  29 

A  REPLY  TO  M.  F.  R. 
By  H.  K. 

In  responding  to  the  request  of  M.  F.  R.  in  the  November  Digest, 
that  an  ethical  man  reply  to  his  article,  I  would  say  that  I  believe  I  have 
at  least  one  qualification  for  the  task: — Namely,  that  for  twenty  years 
I  have  remained  an  ethical  man,  in  spite  of  the  fact  that  I  have  a  very 
small  practice,  along  with  the  responsibilities  of  a  family.  Of  course, 
advertising  holds  no  temptation  to  a  man  of  large  practice. 

I  believe  that  a  brief  answer  will  meet  the  case  of  all  those  who,  like 
M.  F.  R.,  so  freely  use  the  pages  of  the  Digest  to  advocate  disregard  of 
the  dental  code  of  ethics.  All  dentists  are  in  honor  bound  to  play  the 
game  according  to  the  rules.  Let  the  advertising  men  and  the  quacks 
take  a  leaf  out  of  the  sportsman's  book.  All  of  them  know  what  happens 
to  the  football  player  who  violates  the  rules,  or  to  the  prize-fighter  who 
fouls  an  opponent.  Even  in  so  crooked  a  game  as  gambling  the  unfair 
player  is  ostracized,  simply  because  he  will  not  abide  by  the  rules  of  the 
game. 

None  of  us  was  born  a  dentist.  We  entered  the  profession  by  delib- 
erate choice,  and  so  entering  found  certain  rules  in  vogue,  which  are 
known  as  the  dental  code  of  ethics.  Such  rules  constitute  an  integral 
part  of  the  profession.  In  this  respect  dentistry  is  not  peculiar,  for  every 
calling,  from  law  and  medicine  down  to  hod-carrying,  has  its  code.  True, 
in  every  calling  men  are  to  be  found  who  will  not  follow  the  code,  which 
has  given  use  to  such  terms  as  '* shyster/'  '* quack''  and  ''scab."  The 
unfair  man  must  pay  the  price. 

Every  calling  contains  men  who  are  devoid  of  the  ethical  sense,  and 
to  preach  ethics  to  them  is  to  cast  pearls  before  swine.  If  life  holds  no 
higher  ambition  than  the  making  of  money,  then  the  advertiser  and  the 
quack  are  fully  justified.  But  some  men  are  so  constituted  that  they 
care  more  for  the  respect  of  their  fellows  (and  their  own  self-respect)  than 
for  money,  and  would  choose  to  remain  poor,  rather  than  degrade  a 
profession,  and  incidentally  degrade  themselves.  If  a  man  can  do  noth- 
ing to  elevate  this  calling,  he  should  at  least  .leave  it  no  worse  off  than  he 
found  it.  Common  honesty  demands  that  much.  He  was  not  taught 
his  profession  in  order  that  he  might  mangle  it. 

I  am  aware  that  advertising  and  quackery  present  the  unethical  man 
only  in  his  grossest  form,  and  that  back  of  him  stands  his  sly  brethren, 
who  are  forever  given  to  the  detraction  of  their  competitors.  The  latter 
perhaps,  are  the  worst  ''scabs"  of  all. 

Owing  to  its  comparative  newness  and  the  grade  of  men  who  have 


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30  THB  DENTAL  DIGEST 

been  allowed  to  matriculate  in  dental  colleges,  dentistry  contains  a  far 
larger  proportion  of  unethical  men  than  law  or  medicine;  but,  notwith- 
standing the  financial  success  that  appears  to  attend  the  imethical  men, 
signs  are  not  wanting  that  their  days  are  numbered.  The  requirements 
of  the  profession  are  continually  calling  for  men  of  higher  caliber,  and 
ere  long  the  colleges  will  consult  their  own  interest  as  well  as  the  interest 
of  the  profession  and  the  public,  by  weeding  out  men  who  lack  compre- 
hension of  those  finer  elements  that  characterize  the  truly  professional 
man.    Until  that  day,  "virtue  is  its  own  reward." 

Answer  no.  2  to  M.  F.  R. 

Editor  Dental  Digest:— 

"Can  you  answer  this  man,"  was  the  heading  on  a  communication 
by  M.  F.  R.  I  do  not  know  what  M.  F.  R.  stands  for,  but  my  little 
daughter  suggested  "Money  for  Rot." 

It  is  deplorable  to  learn  that  a  man  whom  I  suppose  has  a  dental 
college  education,  can  indulge  in  money-making  as  described  in  your  last 
issue. 

I  think  the  most  of  the  men  who  read  the  Digest  will  put  aside  the 
article  with  a  sigh  as  I  do  when  I  glance  at  our  local  Sunday  newspaper 
supplements  with  heading  such  as  this — "Have  rats  souls?"  and  then  a 
half  life  size  picture  of  the  particular  "nutty"  professor  who  produced  the 
essay. 

M.  F.  R.  says  that  his  shrewd  business  man  got  business  on  the  square, 
but  what  about  the  "secret"  local  anesthetic?  I  have  my  opinion  of  M. 
F.  R.  who  feels  neglected  because  the  Dental  Society  to  which  he  perhaps 
paid  a  dollar  or  two  did  not  help  him  out  in  dull  times.  I  hope  M.  F.  R. 
will  rest  from  future  contributions  about  his  wrinkles,  for  about  two  years 
exploit  in  his  home  city  and  then  report  on  the  permanency  of  his  ad- 
venture. 

N.  J.,  Minneapolis. 


Abscess  Lancet: — For  an  ideal  abscess  lancet,  take  a  new  Duplex 
Safety  Razor  blade,  divide  at  opening  in  centre.  Make  point  on  one 
end;  on  other  make  shank  to  fit  cane  socket  handle;  cement  in  place. 
Then  you  have  a  lancet  that  will  cut  without  tearing.  The  lips  of 
wound  will  have  tendency  to  flare  open  instead  of  closing  up. 

C,  I.  Faison,  D.D.S. 
Dallas,  Tex. 


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MY  WAY  OF  FIGURING  THB  COST  OF  AN  INLAY  31 

MY  WAY  OF  FIGURING  THE  COST  OF  AN  INLAY 
By  C.  A.  G.,  Grand  Rapids,  Mich. 

For  many  years  I  managed  my  ofl&ce  in  a  haphazard  way,  but  one 
fortunate  day  I  ran  across  the  first  edition  of  ** Brother  Bill's  Letters/' 
After  beginning  the  book,  I  did  not  drop  it  until  it  was  finished  and,  I  can 
assure  you,  it  was  a  "hip,  hip,  hurrah! "  for  Brother  Bill. 

My  first  move  toward  a  better  method  of  managing  my  ofl&ce  was  to 
raise  my  prices  for  dental  services  to  those  received  by  first  class  dentists 
in  our  dty .  With  fear  and  trembling  and  much  doubt  as  to  results  I  made 
the  experiment  of  higher  prices  on  my  first  new  patient.  The  result  was 
so  satisfactory  that  from  that  time  on  I  became  braver  and  the  higher 
prices  were  soon  a  fixed  habit. 

It  is  my  opinion  that  the  only  safe  plan  for  the  average  dentist  to  fol- 
low is  to  place  his  prices  on  a  par  with  those  of  the  leading  dentists  of  his 
conununity.  Should  he  be  more  than  an  average  dentist,  a  sort  of  a  wiz- 
ard in  fact,  he  may  be  able  to  hold  his  prices  above  the  leading  men  of 
the  profession,  but  not  otherwise. 

My  next  and  most  important  move  was  to  make  a  complete  refurnish- 
ing of  my  office,  for  as  the  clientele  who  were  to  pay  the  advanced  prices 
must  come  from  a  wealthier  class  of  people  they  would  demand  an  up-to- 
date  equipment,  as  well  as  first  class  dental  services. 

Various  plans  were  adopted  by  me  from  time  to  time  for  putting  my 
business  on  a  permanent  financial  basis.  But  all  of  these  were  finally 
abatidoned  for  one  which  I  have  termed  the  salary  plan;  the  adoption  of 
which  I  would  recommend  to  all  dentists  whether  young  or  old.  This 
plan  briefly  stated,  was  to  put  myself  on  a  weekly  salary,  to  which  I  ad- 
hered as  strictly  as  though  I  had  been  in  the  employ  of  some  other  den- 
tist. At  first  I  decided  to  estimate  this  salary  by  the  amounts  which  my 
compeers  were  receiving  and  those  whom  I  knew  best  at  that  time  were 
making  from  twenty-five  to  forty  dollars  per  week.  I  took  the  highest 
amount,  forty  dollars,  and  every  Saturday  night  took  home  to  wifey  an 
envelope  containing  a  forty  dollar  check.  This  check  was  to  take  care 
of  all  expenses  incurred  outside  of  the  office. 

In  a  few  months  I  was  able  to  raise  my  salary  to  fifty  dollars  per 
week  and  now  for  a  year  I  have  been  drawing  seventy-five  dollars  per 
week.  It  is  my  ambition  to  raise  this  salary  to  one  hundred  dollars  per 
week  after  January  first,  1916. 

To  draw  this  salary  I  found  it  necessary  to  raise  prices  from  time  to 
time  and  to  adopt  ethical  methods  of  advertising,  which  is  another  story. 


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32 


THE  DENTAL  DIGEST 


Enthusiasm  and  the  art  of  salesmanship  also  entered  into  these  successful 
conditions. 

The  second  requisite  in  adopting  the  salary  plan  was  to  decide  as  to 
the  number  of  hours  per  day  and  the  number  of  days  per  month  to  be 
spent  at  work.  After  careful  consideration  seven  hours  a  day  and  twenty 
days  a  month  seemed  the  average  time  consumed. 

The  overhead  expenses  of  a  dental  office  vary  so  largely  in  different 
cases  that  it  is  difficult  to  put  a  fixed  price  on  this  matter.  In  my  own 
case,  after  figuring  rent,  investments  in  equipment  and  other  incidental 
expenses  with  ten  per  cent,  depreciation  of  same,  I  found  it  cost  me 


;:AU-^ii 


"Every  Saturday  night  I  took  home  to  wifey  an  envelope  containing  a  forty-dollar  check" 

approximately  one  dollar  an  hour,  for  seven  hours  a  day,  for  twenty  days 
a  month.  With  my  salary  of  seventy-five  dollars  per  week,  which  figures 
two  dollars  an  hour  for  the  same  number  of  hours  and  days,  I  found  that 
I  must  average  twenty-one  dollars  per  day,  or  four  hundred  and  forty 
dollars  per  month.  I  am  able  to  do  this  by  making  a  charge  of  six  dollars 
for  the  inlay  mentioned  and  a  proportionate  charge  for  all  other  time 
spent  by  myself  at  the  chair.  My  assistant  does  all  casting,  finishing, 
etc.,  giving  me  all  my  time  at  the  chair  which  would  average  four  hours, 
a  day  of  hard,  nervous  work.  With  these  figures  it  will  be  seen  that  I 
have  plenty  of  time  for  tennis,  fishing  and  traveling  in  the  summer  and 
hand  ball  for  exercise  in  the  winter,  all  of  which  keep  me  in  fine  condition 
physically  and  mentally. 


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'^o 


iiirninmiiiit«iuNutii(iHiuitiiiiiiNiimiiiiHiiMi^ 


ii 


.^,  BROTHER  BILES  . 
"'"       LETTERS      Ij 

lUiiiuiiiintiU'luioiuuiuijniuiiHiiitiiiiuvBuuiniiiliiiifiiiiiiNHiiiMrtHRiKiiiivniMM 


My  Dear  Jim:— 

I  note  your  resentment  of  my  statement  that  your  low  fees  have 
wrought  injustice  to  yourself  and  your  patients.  You  admit  that  your 
fees  are  low  and  that  you  wish  they  were  higher,  but  you  say  that  as  long 
as  they  are  what  they  are,  you  are  happy  in  the  thought  that  they  have 
done  a  great  deal  of  "good." 

I've  discovered,  since  reading  your  letter,  that  you  and  I  have  very 
different  meanings  for  the  word  *'good."  Of  course  I  don't  know  exactly 
what  you  mean  by  **good''  but  from  your  letter  I  think  you  mean  that 
because  of  your  low  fees  your  patients  are  better  off  than  they  would  be 
if  you  had  charged  them  remunerative  fees. 

First,  however,  I  want  to  give  you  my  idea  of  doing  **good''  to  paying 
patients.  It  is  to  render  them  the  highest  form  of  service  I  can,  to  teach 
them  its  worth  and  to  charge  fees  that  will  make  them  respect  my  work 
and  me. 

Now  your  idea  of  "good''  seems  to  be  in  terms  of  money.  Of  course 
you  don't  define  it  so  out  loud,  or  perhaps  even  in  your  own  thoughts^ 
but  if  I  read  your  letter  correctly  you  try  to  be  happy  in  the  thought  that 
your  low  fees  have  saved  your  patients  money.  The  fifty  cents  or  five 
dollars  you  let  them  carry  away  in  their  pockets  is  the  expression  of  your 
idea  of  doing  them  "good." 

Your  idea  might  impress  me  more  if  I  didn't  know  the  town,  but 
you  must  remember  that  I  grew  up  there  and  that  I  know  about  the 
financial  condition  of  all  the  prominent  people  except  those  who  have 
come  in  since  my  day.  I'm  going  to  use  this  knowledge  to  see  if  I  can't 
prove  your  idea  of  "good"  is  wrong. 

When  I  visited  you  awhile  ago,  I  watched  several  of  your  operations 
for  old  friends  of  mine,  and  I  am  sure  you  did  not  do  them  "good"  in  any 
form.  Take  Harry  Herter  for  example,  who  owns  half  the  bank  and  half 
a  dozen  other  things  about  town.  He  came  in  to  have  you  clean  his 
teeth,  as  he  does  every  month.  You  spent  half  an  hour  on  his  teeth  and 
charged  him  a  dollar.     I  didn't  run  an  instrument  up  under  the  bifurca- 


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34  TH£  DENTAL  DIGEST 

tion  of  the  upper  first  molars,  where  the  gum  has  receded,  but  I  no- 
ticed you  didn't  give  him  anything  like  the  amount  and  kind  of  service  I 
think  his  mouth  needs,  and  would  be  much  better  for  receiving.  Also, 
you  should  have  charged  him  $1.75  for  the  half  hour  you  gave  him,  and 
then  you  wouldn't  have  needed  to  go  down  to  the  office  and  work  that 
evening  to  make  up  the  loss.  It  would  have  been  much  better  for  Harry, 
in  teeth,  if  you  had  put  in  two  hours  and  charged  him  $7. 

Perhaps  you  think  saving  Harry  the  spending  of  the  75  cents  you 
didn't  charge  him,  was  doing  him  "good.'*    YouVe  known  and  serv^ed 


"If  you  can  make  Harry  put  down  his  cigar  long  enough  to  hold  a  mirror  and  let  you  show 
him  what  recession  in  his  gums  promises" 

Harry  for  a  long  time,  and  some  day  when  you  are  going  by  the  bank, 
you  might  go  in  and  say  "Harry,  I  feel  that  I  should  like  to  do  you  some 
good;  here  is  75  cents."  I've  known  Harry  and  his  picturesque  profanity 
since  we  were  boys,  but  if  you  can  imagine  what  he  would  say,  you  can 
do  better  than  I.  Yet  that  would  be  better  than  the  basis  on  which  you 
are  serving  him. 

I'll  tell  you  what  will  happen  when  some  bright  young  dentist  who 
understands  the  proper  basis  for  doing  "good"  comes  to  town.  He'll 
serve  and  educate  his  patients  so  well  that  they'll  look  up  to  him  and 
brag  about  him.  And  some  day  Harry  will  go  in  there  to  get  his  teeth 
"cleaned "  and  will  get  a  new  experience  in  service  and  will  pay  $5  or  more 
for  it,  and  will  say  to  him  just  as  I've  heard  patients  say  many  times. 


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BROTHER  BILL'S  LETTERS  3^ 

"Doctor,  I  wish  someone  had  done  this  for  me  years  ago/'  and  go  out 
thinking  about  the  service  rather  than  about  the  fee. 

Take  Mrs.  Hutchins  as  another  example.  You  put  a  mesioocclusal 
inlay  in  her  lower  right  first  molar  and  seemed  quite  pleased  when  you  got 
$7  for  it.  You  got  all  the  inlay  was  worth  because  it  will  not  do  a  number 
of  very  important  things  it  should.  As  your  practice  brings  in  $3,500 
per  year,  that  inlay  cost  you  about  $8.40.  The  occlusal  surface  was 
practically  flat.  It  wasn't  formed  to  hold  the  opposing  tooth  in  position, 
or  to  articulate  with  it,  or  to  divert  the  food  from  the  contact  point  into 
the  embrasures  and  so  preserve  the  papilla.  The  inlay  seemed  to  fit  the 
margins  well  enough,  but  the  upper  molar  slides  just  a  little  when  it  oc- 
cludes on  the  inlay.  In  a  little  while  that  upper  molar  will  move  to  where 
it  doesn't  have  to  slide,  and  that  will  be  out  of  proper  alignment.  I  know 
because  I've  made  the  same  mistake.  Food  will  crowd  between  the 
contact  point  and  the  adjoining  tooth  because  the  inlay  isn't  shaped  to 
divert  it,  and  a  "meat-hole"  will  result. 

Now  if  you  had  spent  30  minutes  more  on  the  occlusal  surface  of  that 
inlay,  if  you  had  mounted  your  counterdie  and  opposing  model  so  that 
you  could  have  moved  them  laterally  and  "chewed  out  the  articulation" 
and  then  shaped  the  surface  to  divert  food  away  from  the  contact  point, 
and  charged  Mrs.  Hutchins  the  $11  you  would  have  been  entitled  to  at 
your  costs,  you  would  have  preserved  that  tooth  indefinitely,  instead  of 
insuring  trouble  in  a  few  years  as  you  have  now.  I  don't  think  you  did 
Mrs.  Hutchins  "good."  I  think,  as  the  boys  say,  you  "did  her  up  good 
and  brown,"  because  she's  going  to  lose  that  tooth  10  years  before  she 
should,  and  the  money  you  charged  for  the  work.  And  that  will  discredit 
dentistry  and  you  in  her  eyes. 

If  you  want  to  save  the  Hutchins  family  money,  try  the  plan  I  sug- 
gested for  Harry  Herter.  Mr.  Hutchins  isn't  rich,  but  he  is  about  100 
times  better  off  than  you  are,  and  is  a  self-respecting  merchant.  You  try 
saving  them  money  at  the  expense  of  service  they  need  and  let  them  find  it 
out,  and  see  how  long  you  will  continue  to  serve  them.  They  know  where 
true  economy  lies  and  they  are  too  shrewd  to  always  be  fooled  about  it. 

Of  course  I  know  people  in  the  town  to  whom  every  dollar  is  precious. 
There  are  old  Mr.  Day  and  the  Allen  sisters  and  half  a  dozen  others  whom 
you  serve,  who  haven't  a  cent  to  spare,  but  who  are  as  fine  people  as  any 
in  town.  They  aren't  poor  people;  they're  just  short  of  worldly  goods. 
You  can  do  fliese  people  real  "good"  by  rendering  them  a  good  quality 
of  service  at  low  fees  and  you  ought  to  be  in  a  financial  position  where  it 
would  be  a  pleasure  to  you,  a  little  "sweetening,"  so  to  speak,  of  your 
daily  labors. 

The  trouble  is  you  have  mixed  your  people  all  up.    Because  you  can 


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36 


TH£  DENTAL  DIGEST 


do  these  people  good  by  serving  them  at  low  fees,  you  have  transferred 
that  idea  to  everybody.  You  treat  them  all  alike.  That  has  been  a 
failure  for  most  of  your  patients  and  for  yourself  and  your  family. 

People  like  Harry  Herter  and  Mrs.  Hutchins  have  spent  their  lives 
trying  to  get  value  for  their  money.  In  all  things  concerning  which  they 
have  been  educated,  they  know  where  true  economy  lies,  and  they  are 
willing  to  spend  $io  now  to  save  $25  in  five  years  if  you  can  show  them 
the  saving.     If  you  can  make  Harry  put  down  his  cigar  long  enough  to 


"Compare  the  prices  paid  for  toys  this  Christmas  with  the  prices  our  parents  paid  for 

toys  for  us" 

hold  a  mirror  and  let  you  show  him  just  what  recession  in  his  gums  prom- 
ises for  the  future,  and  then  explain  what  you  can  do  by  keeping  every 
surface  polished  and  free  from  irritation,  and  then  that  it  will  take  long 
enough  to  cost  him  $5  a  treatment,  he  will  say  **go  to  it.  Doc,  go  to  it.'' 
You  would  then  address  yourself  to  the  form  of  appreciation  he  under- 
stands, present  expense  but  final  economy.  And  you  could  feel  happy 
in  doing  it  because  you  will  preserve  his  teeth  much  longer  than  you  will 
with  the  present  treatment. 

If  you  had  explained  to  Mrs.  Hutchins  what  the  present  form  of  inlay 
at  $7  will  do  to  her  mouth  in  from  2  to  3  years,  and  what  the  other  form 
of  inlay  might  be  expected  to  do,  she  would  probably  have  thought  a  mo- 
ment and  said  **  Doctor  are  you  quite  sure  it  will  be  worth  the  difference? '' 
and  if  you  replied,  **  Quite  sure,"  she  would  have  said,  *^It  seems  a  little 


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BROTHER  BILL'S  LETTERS  37 

high,  but  I  want  to  save  my  teeth,  and  you  may  do  as  you  suggest." 
And  when  she  went  out  with  that  inlay,  you  could  have  been  happy  in 
the  thought  that  it  would  serve  her  indefinitely. 

With  proper  fees  from  Harry  and  Mrs.  Hutchins  and  a  hundred 
others,  you  would  be  in  a  financial  position  to  serve  old  Mr.  Day  and  the 
Allen  sisters  and  a  few  others  at  purely  nominal  fees. 

I  contend  that  your  idea  of  doing  "good"  is  wrong,  that  you  do  not 
good  but  evil  to  all  concerned.  It  is  time  to  wake  up,  to  take  your  eyes 
for  a  moment  from  teeth  and  look  at  people.  Observe  them  in  the  stores. 
Compare  the  prices  they  have  paid  for  toys  this  Christmas  with  the 
prices  our  parents  paid  for  toys  for  us.  Note  whether  the  shoddy  toys  at 
low  prices  are  bought  by  even  those  people  who  are  in  moderate  circum- 
stances. Ask  Mr.  Hutchins  to  tell  you:  He  knows.  When  I  compli- 
mented the  appearance  of  his  store,  he  told  me  that  he  now  has  to  carry  a 
much  better  line  of  goods  than  formerly  or  lose  his  business.  Said  he  "I 
now  sell  thousands  of  dollars'  worth  of  goods  that  I  never  thought  this 
community  would  buy  on  account  of  the  high  first  cost." 

Get  your  service  on  a  modern  basis.  Do  "good"  in  teeth  to  people 
who  have  money,  and  in  both  teeth  and  money  to  those  who  are  short  on 
worldly  goods. 


"NOW  BLOW— BLOW  HARD" 

In  the  rear  of  the  nose  just  above  the  soft  palate  are  the  opening 
of  the  eustachian  tubes  leading  to  the  middle  ear.  Hard  blowing  of 
the  nose  may  force  colonies  of  bacteria  through  one  of  these  tubes  into 
the  middle  ear,  producing  inflammation  with  resulting  ear  ache. 

If  not  at  once  checked  by  opening  the  ear  drum  and  disinfecting 
the  ear,  deafness  may  result,  or  the  inflammation  may  extend  into  the 
spongy  bone  of  the  mastoid  process.  In  the  latter  case,  it  is  probable 
that  a  hole  will  need  to  be  chiseled  through  the  outer  layer  of  the  skull, 
the  diseased  bone  excavated,  and  the  cavity  sterilized,  or  death  may 
ensue.  Many  a  mother  has  caused  the  death  of  her  offspring  by  put- 
ting a  handkerchief  to  his  nose  and  saying,  "Now  blow.  Blow  hard!" 
Mastoid  abscesses  are  serious  afflictions,  and  by  no  means  uncommon. 
One  of  my  friends  averages  more  than  one  mastoid  operation  a  day 
through  the  year.    Dr.  Wm.  L.  Hooper,  Tufts  College. — Healthy  Home. 


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RAGTiOL  Hints 


[This  department  is  in  charge  of  Dr. 
V.  C.  Smedley,  604  California  Bldg., 
Denver,  Colo.  To  avoid  unnecessary  de- 
lay, Hints,  Questions,  and  Answers  should 
be  sent  direct  to  him.]* 

A  Method  of  Applying  Arsenical  Paste. — A  safe  way  to  apply 
arsenical  paste  in  a  cavity  is  to  take  an  automatic  amalgam  carrier,  place 
a  small  piece  of  cotton  in  barrel  and  place  the  arsenical  paste  on  the 
cotton;  it  can  then  be  applied  without  fear  of  falling  on  the  mucous 
membrane. — George  E.  Cox,  D.D.S.,  Wilmington,  Del. 

1.  Three  Hints  That  I  Find  Practical. — ^Buy  a  one  quart  Thermos 
bottle  and  have  warm  water  at  your  chair  for  three  days  with  one  heating. 

2.  In  large  canals  when  pulp  is  difficult  to  remove,  place  two  small 
broaches  in  holder  at  once  and  remove  the  pulp  first  time. 

3.  In  using  arsenic  in  deep  interproximal  cavities  always  have  a 
piece  of  temporary  stopping  tight  against  gingival  margin,  then  apply 
treatment  and  cement.  This  forces  away  any  overhanging  tissue  from 
cavity  and  does  away  entirely  with  dangers  of  arsenical  poisoning. — 
A.  C.  Sloan,  D.D.S.,  Baldwin,  Wis. 

To  Keep  Water  Sterile  for  Hypodermic  Work. — Sterile  water 
for  hypodermic  work  can  be  kept  clean  by  using  the  glass  dome  of  the 
'^Nontoxo  Sterilizer"  to  cover  a  ground  glass  stoppered  bottle  of  four 
or  six  ounces,  bottle  to  be  used  on  a  clean  glass  slab.  Makes  a  fairly 
good  joint  to  keep  out  **bugs.'' — M.  V.  Baker,  D.D.S.,  Marysville, 
Wash. 

To  Compensate  for  Shrinkage  in  a  Large  Gold  Inlay. — Where 
a  cast  gold  inlay  is  to  be  made  for  a  cavity  involving  the  mesial,  occlusal 
and  distal  surfaces  of  a  bicuspid  or  molar,  if  there  is  any  shrinkage  the 
inlay  will  invariably  show  a  defective  line  at  the  gingival  margins.  To 
overcome  this,  the  gingival  margins  of  the  cavity  should  be  quite  freely 
beveled  so  that  the  inlay  will  cover  them  with  a  lap  joint  instead  of  a 
butt  joint.  Even  if  there  is  a  slight  shrinkage  the  thin  lap  of  gold  can  be 
burnished  down  to  the  cavity  margin  so  that  when  cemented  the  inlay 
will  perfectly  seal  the  cavity. — I.  D.,  The  Denial  Review. 

*In  order  to  make  this  department  as  live,  entertaining  and  helpful  as  possible,  questions 
and  answers,  as  well  as  hints  of  a  practical  nature,  are  solicited. 


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PRACTICAL  HINTS  39 

To  Prevent  Thumb-Sucking  in  Children. — Dr.  Geo.  H.  Hen- 
derson calls  attention  to  a  very  ingenious  method  of  preventing  thumb- 
sucking  suggested  to  him  by  Dr.  Truman  W.  Brophy.  Make  a  paste- 
board cuff  of  the  right  size  and  length  to  slip  on  the  arm,  small  enough 
not  to  slip  off  the  hand.  Sew  cotton  or  other  material  on  the  edge  to 
prevent  it  from  irritating  the  hand.  It  can  be  boimd  with  adhesive  tape 
or  straps  and  buckles.  This  will  prevent  any  use  of  the  elbow,  and  it  is 
much  more  humane  than  the  use  of  bitter  drugs  and  other  such  expedi- 
ents.— The  Dental  Review, 

Method  of  Separating  and  Regaining  Space  Where  Teeth 
HAVE  Been  Lost  for  Sometime. — Cases  are  often  presented  to  us 
where  it  is  desirable  to  reclaim  the  use  of  a  root  that  has  lost  its  crown. 
However,  upon  examination,  we  find  that  the  crowns  of  the  teeth  ad- 
joining the  space  have  drifted  out  of  normal  contact  with  their  neighbors 
to  a  point  where  it  is  not  possible  to  place  a  crown  of  sufficient  width  and 
size.  This  condition  may  be  obviated  by  using  an  old  but  effective 
method  which  is  as  follows:  Place  the  end  of  an  elm  stick  in  a  vise  and 
compress  imtil  it  can  be  slipped  into  the  space  to  be  separated,  and  sawed 
off  short  enough  to  avoid  interfering  with  the  articulation.  In  cases 
where  a  very  short  root  is  to  be  reclaimed,  a  piece  of  softened  gutta 
percha  may  be  placed  over  the  root  end  to  force  the  gum  tissue  away  and 
the  wedge  inserted  over  it.  Sufficient  expansion  of  the  wood  will  take 
place  as  soon  as  the  saliva  comes  in  contact  with  it,  to  produce  a  gradual 
and  quite  comfortable  separation  which  will  continue  for  several  hours. 
It  is  well  not  to  force  this  wedge  in  too  tightly,  since  a  too  rapid  separa- 
tion will  result  with  much  discomfort  to  the  patient.  In  most  cases  one 
wedge  worn  from  twenty-four  to  forty-eight  hours  will  provide  the  de- 
sired space,  while  in  some  cases  two  wedges  may  be  necessary. 

This  method  not  only  has  the  effect  of  producing  a  separation  but  has 
a  far  more  important  one,  i.e.,  forcing  the  drifted  adjoining  teeth  back 
into  firm  contact  and  tilting  their  occluding  surfaces  into  correct  align- 
ment and  articulation,  thereby  eliminating  one  of  the  fertile  causes  of 
pyorrhea  pockets.  There  need  *be  no  fear  of  Fosing  the  space  obtained, 
while  the  crown  is  being  made  and  adapted,  since  the  wedge  may  be 
removed  and  replaced  as  often  as  necessary.  Hickory  was  formerly 
recommended  for  making  these  compressed  wedges,  but  I  have  found  that 
ielm  is  better  since  it  is  a  soft  wood  that  will  admit  of  considerable  com- 
pression without  splitting,  and  will  take  up  moisture  more  rapidly. — 
Lewis  G.  Watkins,  D.D.S.,  Detroit,  Mich. 

A  Time-Saving  Hint. — ^When  treating,  and  in  some  cases,  when 
filling,  an  upper  tooth,  excepting  the  second  and  third  molars,  a  cloth 


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40  TH£  DENTAL  DIGEST 

napkin  can  be  secured  with  a  clamp  to  a  tooth  distally  located  from  the 
one  to  be  operated  upon,  and  by  placing  a  cotton  roll  under  the  lip  or 
cheek,  as  the  case  may  be,  all  moisture  is  excluded  from  the  field  of 
operation  for  a  sufficient  length  of  time  to  enable  you  to  render  the  service 
required.  This  method  can  be  adopted  in  most  cases,  but  of  course  some 
cases  cannot  be  managed  in  this  way,  requiring  the  rubber  dam.  Anyone 
making  use  of  the  napkin  as  indicated  above  will  save  much  valuable 
time,  and  cause  less  discomfort  to  the  patient. — H.  A.  Cross,  D.D.S., 
Chicago,  111. — The  Denial  Review. 

Extracting  a  Post  from  a  Frail  Root. — In  ?xtractmg  a  post  from 
a  frail  root  with  a  post  puller  there  is  always  danger  of  splitting  the  root. 
The  likelihood  of  this  happening  may  be  reduced  to  the  minimum  by 
taking  a  piece  of  twenty-eight-gauge  German  silver  plate,  cut  a  hole 
through  it  large  enough  to  pass  over  the  post  and  trim  into  a  disk  about 
the  size  of  the  root  face.  This  disk  may  then  be  placed  on  the  root  with 
post  projecting  through  its  centre.  The  post  puller  may  then  be  placed 
in  position  and  as  it  is  tightened  the  part  of  the  instrument  which  is 
intended  to  bear  on  the  root  rests  against  the  metal  disk  and  does  not 
slip  or  spread  and  the  post  may  be  drawn  with  safety.  If  the  face  of  the 
root  is  uneven  from  decay,  a  bit  of  base-plate  gutta  percha  may  be 
molded  into  the  cavity,  the  disk  pressed  into  place  and  chilled  with  cold 
water,  giving  an  even  base  for  the  instrument  to  press  against. — ^J.  A. 
Bullard,  D.D.S.,  Chicago,  lU.—The  Denial  Review. 

Water  and  Teeth. — As  a  general  rule,  water  with  high  total  solid 
residue,  including  a  large  amount  of  calcium  salts,  is  not  favorable  to  the 
health.  The  soundness  of  the  teeth,  however,  is  in  direct  proportion  to 
the  degree  of  hardness  of  the  water  used  in  the  locality  in  question.  The 
finest  dentition  was  found  in  districts  where  the  water  contained  mag- 
nesium as  well  as  calcium  salts.  The  former  are  stated  to  harden  the 
enamel. — Rose,  Giorn.  farm.  Chim.;  Ghent,  Abslr.  {British  Journal  of 
Denial  Science.) 

Rendering  Cork  Stoppers  Impermeable.— In  order  to  render  cork 
stoppers  impermeable  to  alcohol  and  acids,  they  are  dipped  in  a  cold 
solution  of  rubber  in  chloroform,  and  allowed  to  dry  in  the  air  until  the 
chloroform  has  evaporated.  Another  method  consists  in  dipping  the 
corks  into  very  hot,  though  not  boiling,  paraffin  for  about  five  minutes, 
and  allowing  them  to  dry  thoroughly. — Journ.  Denlaire  Beige.  (British 
Journal  of  Denial  Science) 


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QUBSTIONS  AND  ANSWERS  41 

QUESTIONS  AND  ANSWERS 

Question. — Some  time  ago  I  attempted  to  prepare  and  fill  some  cavities 
for  a  relative  (a  boy  of  8  years).  He  was  rather  unruly  and  so  I  had  his 
sister  take  him  to  another  dentist,  as  I  could  see  no  way  to  prepare  the 
cavities  except  by  using  the  dental  engine.  The  cavities  to  be  filled 
were  small  pit  and  fissure  cavities  where  an  explorer  would  enter  nicely. 

When  the  boy  returned  I  was  informed  by  his  sister  that  no  engine 
was  used  and  all  four  ist  molars  were  filled.  Looks  like  a  miracle  to  me. 
I  felt  a  bit  delicate  about  the  matter  and  asked  no  questions.  Can  you 
suggest  how  such  a  stunt  can  be  performed?  Hope  I  have  made  a  clear 
impression  as  to  the  class  of  cavity.  No  other  instrument  than  an  ex- 
plorer would  enter  for  me. — R.  C.  M. 

Answer. — ^Very  frequently  occlusal  cavities  that  barely  receive  the 
p)oint  of  an  explorer  will  have  the  enamel  pretty  well  undermined  by 
decayed  dentine  and  in  such  cases  the  enamel  can  be  quite  easily  broken 
down  with  small  sharp  chisels  and  firm  hand  pressure,  when  the  softened 
dentine  can  be  scooped  out  fairly  well  with  spoon  excavators;  sufficiently 
at  any  rate,  to  hold  a  filling  for  a  few  months  or  a  few  years.  In  fact  I 
think  the  main  part  of  the  opening  up  of  all  such  cavities  should  be  done 
without  the  use  of  the  dental  engine.  But  unless  the  engine  be  used  to 
finish  the  operation,  I  think  the  preparation  is  apt  to  be  quite  incom- 
plete, and  it  is  more  than  likely  that  you  will  be  called  upon  to  refill  those 
cavities  at  some  future  time. — ^V.  C.  S. 

Answer. — Will  you  add  to  your  advice  to  '*H.  B.  W.''  in  Septem- 
ber issue.  See  to  it  that  no  iodine  comes  in  contact  with  the  tissues  of 
oral  cavity  (and  all  cleansing  fluids  have  iodine) ;  after  repeated  cleansing 
he  will  see  a  marked  improvement. — M.  H.  Cazier,  M.D.,  Chicago. 

Answer. — In  reply  to  the  inquiry  of  "R.  C.  M."  (page  646,  October 
Digest),  would  say  that  if  he  will  use  a  preparation  that  is  sold  under  the 
name  of  Velvo  Phenox  his  troubles  with  children's  teeth  will  be  over.  I 
have  used  it  very  freely  in  all  sensitive  cavities  for  several  years.  It  is 
harmless.  Stop  it  in  with  cement  for  two  days  before  operating. — ^D.  W. 
Barker,  D.D.S.,  Brooklyn,  N.  Y. 

Question/ — Referring  to  question  signed  "R.  C,  Wisconsin":  It  is  not 
the  policy  of  this  magazine  to  publish  any  contribution  not  signed  (for 
the  publisher)  with  full  name  and  address  of  sender. — V.  C.  S. 


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42  THE  DENTAL  DIGEST 


AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL 
LITERATURE 

[The  Journal  of  the  National  Denial  Association,  November,  1915] 

Contents 

G.  V.  Black,  M.D.,  D.D.S.,  Sc.D.,  LL.D. 

Original  Communications 

Greene  Vardiman  Black.    By  Charles  E.  Bentley,  D.D.S. 

The  Research  Department 

The  Organization  of  the  Research  Institute  of  the  N.  D.  A. 
By-Laws  of  the  Research  Institute  of  the  N.  D.  A. 

The  Building  and  Endowment  Fund  Plan  for  the  Research  Institute  of  the  N.  D.  A. 
Research  Department  Announcements. 
Dr.  Greene  Vardiman  Black.    By  Weston  A.  Price,  D.D.S. 
Report  of  the  Scientific  Foundation  and  Research  Conunission  to  the  N.  D.  A. 
•Report  of  the  Minnesota  Division  of  the  Scientific  Foundation  and  Research  Commission. 

By  Thomas  B.  Hartzell,  D.M.D.,  M.D.;  Arthur  T.  Henrici,  M.D.;  Harold  J.  Leonard 

D.D.S.,  B.A. 
The  First  Report  of  a  Study  of  the  Composition  and  Properties  of  the  Cements  now  in  Use 

in  Dentistry.    By  Marcus  L.  Ward,  D.D.S.;  Ralph  M.  McCormick,  B.S. 

Proceedings  of  the  House  of  Delegates 

President's  Address.    By  Donald  Mackay  Gallie,  D.D.S. 

First  Session. 

Proceedings  of  the  Board  of  Trustees. 

National  Dental  Association — Secretary's  Cash  Book. 

Itemized  Statement  of  Dbbursements. 

Report  of  the  Treasurer  of  the  N.  D.  A. 

Editorial 

Greeting.    By  Thomas  P.  Hinman,  President. 

Greene  Vardiman  Black.    By  H.  E.  Friesell. 

The  Panama-Pacific  Dental  Congress.    By  Arthur  M.  Flood. 

Conunercialism  vs.  Professional  Ethics. 

REPORT  OF  THE  MINNESOTA  DIVISION  OF  THE  SCIENTIFIC  FOUNDATION 
AND  RESEARCH  COMMISSION 

Oral  infection,  whether  in  the  form  of  apical  abscesses  or  pyorrhea, 
is  frequently  the  sole  cause  of  arthritis  and  rheumatic  affections  of  the 
muscles  and  nerves  as  well  as  joints,  and  seems,  when  present,  to  be 
always  an  associated  cause  where  the  rheumatism  is  of  streptococcal  origin. 
An  arthritis  once  started  by  tonsillitis  or  similar  large  foci,  can  be  kept 
going  by  an  oral  infection  so  slight  as  to  be  scarcely  recogm'zable  in  the 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     43 

radiograph,  and  systemic  diseases  are  continued  by  surprisingly  shallow 
gingivitis,  even  when  the  larger  local  foci,  doubtless  the  originators  of 
the  trouble,  are  removed. 

Our  experience  in  private  practice,  as  well  as  in  the  cases  shown  by  the 
tables,  has  taught  us  that  these  rheumatic  and  arthritic  conditions  are 
markedly  improved  by  removing  the  local  foci. 

Great  emphasis  should  be  laid  on  the  complete  extirpation  of  infected 
foci  in  all  cases.  It  is  not  sufficient  that  the  mouth  or  tonsils  appear  well' 
from  the  outside.  A  minute  examination  with  every  means  available  is 
necessary.  With  the  aid  of  the  X-Ray  and  careful  exploration  it  is  still 
difficult  to  find  all  foci  about  the  teeth.  Without  these  aids  it  is  im- 
possible. When  a  physician  refers  a  patient  suflfering  from  rheimiatism 
or  other  of  the  diseases  liable  to  come  from  dental  infection,  it  is  impossible 
for  the  dentist  to  make  a  complete  determination  without  the  use  of  the 
X-Ray.  It  is  our  experience  and  the  experience  of  others  who  use  the 
X-Ray  a  good  deal  that  the  majority  of  dental  abscesses  give  no  clinical 
sign  of  their  existence.  The  teeth  are  not  sore,  no  swelling  or  palpable 
soft  spot  at  the  root  end  reveals  what  the  radiograph  shows  and  what 
the  subsequent  operation  confirms.  It  is  not  uncommon  to  find  ab- 
cesses  shown  in  the  radiographs  in  cases  in  which  there  are  no  breaks  in  the 
continuity  of  the  pulpal  wall,  as  under  crowns,  fillings,  or  even  sound  teeth. 

Experience  with  a  radiograph  also  shows  that  a  very  large  propor- 
tion of  artificially  filled  roots  subsequently  become  abscessed.  A  study 
made  by  Dr.  Henry  Ulrich  of  this  city  of  a  thousand  radiographs  taken 
at  random  indicated  that  over  70  per  cent,  of  the  artificially  filled  roots 
were  abscessed.  It  has  been  very  rare  that  we  have  extracted  a  tooth 
which  showed  an  abscess  in  the  radiograph  and  failed  to  get  streptococci 
when  we  cultured  from  the  root  end. 

It  is  amazing  to  find  in  well  cared  for  mouths  how  much  pyorrhea  may 
exist  without  being  evident  except  to  painstaking  exploration.  To  those 
familiar  with  the  systemic  results  coming  from  pyorrhea  in  such  large 
proportion  of  cases  and  even  from  a  slight  pyorrhea,  the  careless  ignoring 
and  overlooking  of  such  trouble  on  the  part  of  most  dentists,  seems  noth- 
ing less  than  malpractice. 

In  all  the  cases  which  we  have  tested  for  bacteria,  the  streptococcus 
viridens  has  been  found  in  pyorrhea  pockets  and  apical  abscesses.  Since 
we  have  used  the  greatest  precautions  to  prevent  contamination  from 
the  gum  margin  by  searing  them,  there  would  seem  to  be  no  question  but 
that  this  organism  is  constantly  present  in  such  lesions.  Whether  it  is 
the  etiologic  micro-organism  in  the  oral  lesion  or  not,  it  is  present  and 
there  can  be  no  doubt  that  it  or  its  toxins  pass  thence  into  the  circulation 
and  cause  arthritis  and  rheumatic  conditions. 


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44  THE  DENTAL  DIGEST 

The  use  of  vaccines,  however,  is  liable  to  create  a  confidence  in  them 
which  is  likely  to  make  the  dentist  less  careful  in  eliminating  all  local 
foci,  and  until  such  local  foci  are  removed  it  can  hardly  be  expected  that 
a  vaccine  will  give  any  permanent  relief.  In  most  of  the  cases  where  we 
were  sure  that  all  local  foci  were  removed,  the  recovery  was  sujQSciently 
rapid  and  complete  to  indicate  that  vaccine  was  not  needed. 

The  heart  cases  studied  are  mostly  endocarditis  as  evidenced  by 
valvular  disease,  usually  insufficiency  of  the  mitral  valve .  Most  of  these 
are  connected  with  rheumatic  trouble. 

In  our  table  of  hospital  patients,  thirty-five  cases  had  a  diagnosis 
indicating  endocarditis.  Of  these,  twenty-three  had  or  had  had  rheu- 
matism, two  had  tuberculosis,  nine  were  associated  with  nephritis,  and 
three  with  neuritis.  The  association  of  endocarditis  with  rheumatic 
conditions  is  well  known,  this  table  merely  serves  to  emphasize  it.  Of 
the  thirty-one  cases  who  had  or  had  had  rheumatism,  twenty-three  had 
endocarditis.  All  of  these  were  wholly  rheumatic  cases,  not  complicated 
by  tuberculosis  or  syphilis. 

The  known  and  apparent  relation  of  these  heart  lesions  to  rheumatic 
conditions,  the  fact  that  all  have  dental  infections,  and  the  fact  that  so 
large  a  proportion  of  the  cases  studied — thirty-five  out  of  sixty-six — 
have  endocardial  lesions,  seems  to  us  to  be  good  clinical  evidence  of  the 
relation  of  such  lesions  to  local  infective  foci  of  the  dental  type. 

The  response  to  treatment  by  foci  removal  in  these  cases  is  slow,  but 
in  the  great  majority  of  cases  is  marked.  These  lesions  are  much  like 
the  bony  deformities  of  arthritis,  in  that  although  the  disease  may  be 
cured  the  scars  remain  and  a  heart  valve  once  injured  by  inflammation  is 
always  there  after  leaky  and  insufficient.  The  best  that  can  be  done  is 
to  stop  the  progress  of  the  disease  and  allow  the  heart  to  compensate. 
Careful  rest  and  slow  building  are  necessary  and  quick  results  cannot  be 
expected. 

The  cases  which  have  yielded  us  the  most  satisfactory  results  during 
the  last  year  have  been  those  diagnosed  as  gastric  ulcer. 

[The  Denial  Register,  November,  1915] 
Contents 

Event  and  Comment. 

First  General  Annual  Report  of  the  Dental  Department. 

A  Tribute  to  Dr.  Chester  Twitchell  Stockwell. 

Porcelain  Facings. 

Is  Boric  Acid  Good  for  Babies? 

The  Importance  of  Sound  Temporary  Teeth  to  Facial  Growth  and  Development. 

Memorial  Resolution. 

Indents. 

Announcements. 

Meetinp3. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE       45 

[Tlie  Dental  Cosmos,  December,  1915] 

Original  Communications 

A  Rational  Appliance  for  the  Correction  of  Palatal  Defects,  Based  on  Original  Studies  of 

the  Action  of  the  Muscles  of  the  Soft  Palate.     By  W.  H.  O.  McGehee,  D.D.S.,  M.  D. 
Modern  Attachments  for  Bridge  Work  and  Stabilizers  for  Loose  Teeth.    By  Jas.  K.  (Jur- 

gess,  D.D.S. 
*Oral  Infections.     By  Nathaniel  Gildersleeve,  M.D. 
*A  System  of  Making  Jacket  Porcelain  Crowns  Without  Fusing.    By  L.  E.  Custer,  A.M., 

D.D.S. 
The  Relation  of  Dentistry  to  Neurology.     By  Christopher  C.  Beling,  M.  D. 
President's  Address     (Pennsylvania  State  Dental  Society).    By  James  G.  Lane,  D.D.S. 
President's  Address    (New  Jersey  State  Dental  Society).     By  Walter  F.  Barry,  D.D.S. 

Correspondence 

.\dvance  Notice  of  the  Use  of  the  Fluid  Extracts  of  Umckaloabo  and  Chijitse  in  the  Treat- 
ment of  Pyorrhea  Alveolaris. 

Proceedings  of  Societies 

Pennsylvania  State  Dental  Society. 
New  Jersey  State  Dental  Society. 

Dentistry  and  the  War 
American  Ambulance  Hospital — Dental  Department.    First  General  Annual  Report. 


Editorial  Department 

Re-discovery. 

Review  of  Current  Dental  Literature. 

Periscope. 

Hints,  Queries,  and  Comments. 

ORAL  INFECTIONS 
By  Nathaniel  Gildersleeve,  M.  D.,  Phil.adelphia,  Pa. 

(Read  before  the  Pennsylvania  State  Dental  Society,  at  its  annual  meeting,  Reading, 

June  22,  1915) 

CAUSES  FOR  LACK  OF  PRESENT  KNOWLEDGE  OF  MANY  ORAL  INFECTIONS 

This  lack  of  knowledge,  it  might  be  stated,  is  due  primarily  to  four 
causes: 

(i)  Lack  of  interest  exhibited  by  physicians  in  local  diseases  of  the 
oral  cavity. 

(2)  Lack  of  scientific  education  in  a  large  proportion  of  dentists, 
owing  to  which  fact  they  have  been  handicapped  in  recognizing  and 
properly  differentiating  various  infectious  conditions  of  the  mouth. 
Those  who  have  Qualified  are  in  many  respects  self-educated,  it  being  but 


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46  THE  DENTAL  DIGEST 

fair  to  state  that  the  dental  practitioner  cannot  be  blamed  so  much  as  the 
dental  schools,  since  sufficient  emphasis  has  not  been  laid  on  this  very 
important  branch  of  oral  medicine  and  surgery.  This  unfortunate  con- 
dition of  aflairs  is  being  corrected  at  the  present  time,  and  when  the  four 
years'  course  is  instituted  in  the  various  dental  colleges,  the  student  will 
have  better  training  in  this  as  well  as  all  other  branches  making  up  the 
curriculum  of  our  dental  colleges. 

(3)  There  has  always  existed  an  inexcusable  lack  of  cooperation  on 
the  part  of  medical  and  dental  practitioners.  The  professional  relation- 
ships of  these  two  bodies  of  men  dealing  with  diseases  of  the  human 
economy  are  yearly  becoming  closer,  each  group  recognizing  more  and 
more  fully  the  fact  that  they  cannot  work  to  the  best  advantage  of  their 
patients  without  this  essential  cooperation. 

(4)  The  fourth  factor  of  importance  is  one  which  can  only  be  over- 
come by  constant  investigation,  namely,  there  are  numerous  organisms 
constantly  existing  in  the  oral  cavity  the  true  significance  of  which  have 
not  been  determined,  owing  to  the  fact  that  endeavors  aimed  toward 
the  isolation  of  some  of  these  microscopic  plants  and  animals  have  not 
as  yet  been  attended  with  success;  furthermore,  the  importance  of  some 
which  have  been  isolated  has  undoubtedly  not  been  fully  recognized,  due 
partially  to  the  haphazard  way  in  which  they  have  been  handled  by  many 
workers,  and  partially  to  the  fact  that  some  of  the  diseased  conditions 
cannot  be  reproduced  in  lower  animals. 

A  RATION.\L  APPLIANXE  FOR  THE   CORRECTION  OF  PALATAL  DEFECTS, 
BASED  ON  ORIGINAL  STUDIES  OF  THE  ACTION  OF  THE  MUSCLES 
OF  THE  SOW  PALATE 

By  W.  H.  O.  McGehee,  D.D.S.,  M.D.,  Cincinnati,  Ohio 
REQUIREMENTS   OF   A   SUCCESSFUL   OBTURATOR 

It  is  now  readily  seen  that  a  successful  obturator  should  be  capable, 
not  only  of  upward  and  downward  movements,  but,  in  order  that  it 
may  remain  in  perfect  adaptation  to  the  boundaries  of  the  cleft  under 
all  circumstances,  should  really  possess  six  distinct  movements,  that  is 
to  say,  vertical  (upward  and  downward),  antero-posterior  (forward  and 
backward),  and  lateral  (right  and  left).  The  appliance  described  is 
designed  with  this  idea  in  view,  and  is  presented  to  the  profession  after 
adequate  and  successful  trial  in  many  clinical  cases. 

THE  NEW  CLEFT  PALATE   APPLIANCE,   AND  A  NEW   TECHNIQUE 
FOR  MAKING   IT 

The  appliance  suggested  consists  of  a  metal  or  vulcanite  plate  with 

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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE      47 

clasps,  vulcanized  or  soldered  into  the  heel  of  which  is  a  clasp-metal 
extension,  on  which  rests  the  hard-rubber  obturator.  From  the  centre 
of  the  metal  extension  projects  upward  through  the  obturator  a  screw- 
cut  gold  post  with  a  nut  on  its  end.  Vulcanized  into  the  hollow  portion 
of  the  obturator  is  a  flexible  clasp  metal  tongue,  through  which  the  up- 
right screw  post  previously  mentioned  passes  and  in  contact  with  which 
it  is  held  by  means  of  the  nut  on  its  end.  On  the  under  surface  of  this 
metal  tongue  is  a  small  gold  hook,  to  which  is  attached  one  end  of  a 
spiral  spring,  the  other  end  hooking  around  the  upright  screw-cut  post. 
Another  spiral  spring  extends  from  a  similar  hook,  vulcanized  into  the 
posterior  part  of  the  upper  hollow  portion  of  the  obturator,  to  the  same 
upright  post. 

A  SYSTEM  OF  MAKING  JACKET  PORCELAIN  CROWNS  WITHOUT 

FUSING 

By  L.  E.  Custer,  A.M.,  D.D.S.,  Dayton,  Ohio 
ADVANTAGES   OF   THE   PORCELAIN  JACKET  CROWN 

The  jacket  crown  possesses  certain  features  which  easily  place  it  at 
the  head  of  all  other  forms  of  porcelain  crowns.  First,  the  strength  and 
durability  of  this  crown  is  testified  to  by  every  dentist  who  has  made  one. 
Dr.  W.  A.  Capon  of  Philadelphia  says,  ^*  After  many  years  of  experience 
with  different  kinds  of  porcelain  jacket  crowns,  I  am  glad  that  I  was 
fortunate  enough  to  recognize  their  efl&ciency  early  in  my  practice. 
When  a  root  has  been  crowned  to  death  and  considered  only  fit  for  ex- 
traction, a  jacket  crown  will  give  it  renewed  life  and  vigor  in  the  majority 
of  cases,  if  it  is  decently  firm  in  its  socket." 

Dr.  Edward  B.  Spalding  of  Detroit  says,  *^The  all-porcelain  jacket 
crown  and  its  modifications  have  displaced  all  other  forms  of  porcelain 
crowns  in  my  practice.  The  gum  tissue  is  always  more  healthy  about  a 
carefully  fitted  and  flush  joint  than  where  a  band  is  used." 

Dr.  George  Schneider  of  Chicago  says,  ''There  are  two  vital  points 
in  favor  of  the  jacket  crown,  namely,  first  it  is  not  necessary  to  remove  the 
natural  crown  in  whole;  second,  you  do  not  endanger  the  root  by  en- 
larging the  canal  for  the  retention  of  a  post." 

Dr.  H.  E.  Jenkins  of  Ironton,  Ohio,  whom  I  have  seen  repeatedly 
drive  a  canine  jacket  crown  of  his  own  make  through  an  inch  pine  board 
without  damage  to  the  crown,  maintains  and  proves  that  it  possesses 
strength  above  any  other  form  of  porcelain  crown. 

The  strength  of  the  jacket  crown  is  due  largely  to  the  natural  post  of 
dentin  within  it,  which  is  a  part  of  the  tooth  itself.  Where  caries  has 
left  but  little  dentin,  this  is  reinforced  by  a  platino-iridium  post  occupying 


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48  THE  DENTAL  DIGEST 

approximately  the  pulpal  space  of  the  tooth.  We  have  never  seen  or 
heard  of  a  root  split  under  a  jacket  crown.  This  cannot  be  said  of  any- 
other  form  of  porcelain  crown. 

A  second  advantage  of  the  jacket  crown,  as  pointed  out  by  Dr. 
Spalding,  is  that  it  makes  a  flush  joint  with  the  root  at  the  cervix.  A 
metal  band  with  its  uncertain  fit  is  thus  done  away  with. 

The  third  advantage  is  the  esthetic  appearance  of  the  completed 
crown.  The  entire  crown  itself  performs  the  functions  of  a  band,  thus 
eliminating  the  unsightly  metal  band  at  the  gum  line. 

The  disadvantages  of  the  jacket  crown  lie  entirely  in  the  technique 
of  its  construction.  The  operator  must  be  skilled  in  the  working  of 
porcelain,  and  I  know  of  no  procedure  in  dentistry  that  requires  so  high 
a  degree  of  skill  and  patience  as  the  making  of  a  porcelain  jacket  crown. 
The  platinum  coping  requires  skill  and  time  in  its  formation,  the  selection 
and  fusing  of  the  proper  shade  of  porcelain  requires  years  of  experience, 
and  then  often  at  the  last  minute  the  esthetic  appearance  of  the  whole 
appliance  may  be  spoiled  by  overfusing.  Another  objection  is  the 
amount  of  time  consumed  in  the  baking  method. 

It  is  a  system  or  procedure  in  which  the  objections  just  enumerated 
are  overcome  that  I  herewith  present,  and  since  I  am  the  inventor  of  the 
first  electric  oven,  it  may  seem  strange  that  I  advocate  a  method  which 
does  not  require  an  oven,  nor  does  it  require  any  special  instruments. 
It  will  also  be  noticed  that  many  steps  of  the  technique  are  old  and  more 
or  less  familiar  to  everyone. 

[Items  of  Interest,  December,  1915] 

Exclusive  Contributions 

Is  Tartar  a  Cause  of  Pyorrhea  Alveolaris?    T}ie  Logical  Test  Applied.    By  G.  F.  Logan, 

D.D.S. 
Note  on  SUnding  Amoeba  in  Dry  Smears,  from  Cases  of  Pyorrhea.     By  Thomas  LeClear. 

ProstJwdontia 

"The  Application  of  the  Chayes  Parallelometer,  the  Parallelodrill  and  Attachments  in  the 
Conservation  of  the  Common  Reciprocal  Functions  of  the  Teeth  Which  are  Used  as  Piers 
for  Bridgework."     By  Herman  E.  S.  Chayes,  D.D.S. 

Orthodontia 

Some  Principles  of  Retention.    By  Martin  Dewey,  M.D.,  D.D.S. 
Discussion  of  Dr.  Dewey's  Paper. 

Society  Papers 

♦Blood  Findings  in  162  Consecutive  Cases  of  Chronic  Oral  Infection  Associated  with  Teeth. 
Bv  Wm.  H.  G.  Logan. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE       49 

•Oral  Sepsis  as  Related  to  Systemic  Disease.    By  W.  H.  Strietmann,  M.D. 
Operative  Procedures  in  Relation  to  Dental  Caries  and  Diseases  of  the  Investing  Tissues. 
By  Arthur  D.  Black,  A.M.,  D.M.,  D.D.S. 

BLOOD  FINDINGS  IN  162  CONSECUTIVE  CASES  OF  CHRONIC  ORAL  INFECTION 
ASSOCIATED  WITH  TEETH 

By  Wm.  H.  G.  Logan 

{Read  before  the  Panama-Pacific  Dental  Congress j  San  Francisco ^  California,  Section  VI, 

September  i,  191 5) 

In  the  examinations  made  in  100  out  of  162  cases  blood  changes  had 
occurred  that  were  held  to  be  the  sequence  of  chronic  oral  infections 
associated  with  teeth. 

ANEMIA 

That  neither  pronounced  nor  moderate  anemia  was  commonly 
associated  with  chrom'c  oral  infections  in  this  series,  as  claimed  by  many 
authors;  however  pronounced  anemia  was  found  once. 

leucopenia 

That  leucopenia  was  more  constant  than  leucocytosis  in  pyorrhea 
cases  where  the  blood  findings  were  abnormal;  furthermore,  leucopenia 
was  more  frequent  in  those  cases  where  the  pyorrhea  pockets  did  not 
involve  the  root  ends  and  in  the  absence  of  periapical  focal  infection 
without  discharging  sinuses. 

LEUCOCYTOSIS 

That  leucocytosis  when  associated  with  pyorrhea  cases  was  most 
frequent  where  the  pyorrhea  pockets  extended  nearly  to  or  did  involve 
the  root  ends. 

That  abnormal  blood  findings  were  present  in  forty-eight  of  the  one 
hundred  and  ten  pyorrhea  cases  examined.  Full  urinalysis  was  made  of 
all  pyorrhea  cases  although  not  here  reported. 

That  leucocytosis  was  present  in  forty-seven  of  the  fifty-two  cases 
of  {periapical  infections  without  discharging  sinuses — but  that  leucopenia 
does  occur  under  the  same  conditions  is  presented  in  Group  6.  Let  the 
foregoing  statement  be  not  misconstrued  to  mean  that  either  leucocytosis 
or  leucopenia  is  always  present  when  a  chronic  periapical  infection  with- 
out a  discharging  sinus  is  found,  for  periods  arise  when  the  effect  of  the 
infective  biproducts  is  so  slight  that  its  result  is  not  manifested  in  a 
blood  change.  But,  since  severe  secondary  infections  could  occur  during 
this  period,  a  focal  infection  although  producing  no  characteristic  blood 


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50  THE  DENTAL  DIGEST 

change  must  always  be  looked  upon  as  a  menace  to  the  health  of  the 
patient  and  its  eradication  demanded. 

PERIAPICAL  INFECTIONS 

One  may  have  a  pulpless  tooth  present  without  a  rarefied  periapical 
area  and  at  the  same  time  have  a  chronic  infective  process  in  the  rem- 
nants of  pulp  tissue,  which  I  have  found  in  three  cases  to  be  account- 
able for  a  serious  secondary  effect. 

Nor  can  one  with  any  degree  of  assurance  eradicate  periapical  in- 
fections by  the  mere  extraction  of  teeth  unless  it  be  accompanied  by  a 
currettement.  Therefore  it  becomes  necessary  to  do  something  more 
than  to  extract  teeth  or  amputate  roots  and  do  an  indifferent  curettement 
to  secure  positive  elimination  of  focal  infections  associated  with  teeth. 

ORAL  SEPSIS  AS  RELATED  TO  SYSTEMIC  DISEASE 

W.  H.  Strietmann,  M.D.,  Oakland,  California 
(Read  before  the  Panama-Pacific  Dental  Congress^  Section  II y  September  7,  igiS») 

ETIOLOGY  OF  ROOT  ABSCESSES 

Let  US  consider  on  the  other  hand  the  etiology  of  root  abscesses. 
Here  I  would  have  you  consider  earnestly  the  causative  factors  spoken 
of  by  Martin  H.  Fischer.  He  calls  attention  to  the  fact  primarily  that 
teeth  are  living  structures.  All  of  us  know  that  living  tissue  of  any  kind 
is  infinitely  more  resistant  to  infection  than  dead  tissue.  Hence  any 
procedure  which  would  tend  to  interfere  with  the  vitality  of  the  tooth 
or  its  surrounding  structures  must  of  necessity  lower  resistance  to  in- 
fection and  predispose  to  local  disease.  Under  this  heading  we  must 
place  the  use  of  arsenic  and  strong  antiseptics  such  as  phenol  tricresol, 
etc.  These  substances  destroy  bacteria  no  doubt,  but  they  destroy 
living  tissue  as  well. 

Then  comes  the  process  known  as  devitalizing  a  tooth.  The  popular 
conception  is  that  this  process  removes  the  nerve  from  the  pulp  canal, 
but  as  Fischer  has  pointed  out,  it  also  removes  the  nutrient  artery  from 
the  centre  of  a  tooth,  which  naturally  results  in  the  death  of  the  tooth 
centrally,  again  producing  a  favorable  ground  for  the  growth  of  bacteria. 
With  the  central  canal  deprived  of  its  blood  supply  the  pericementiun 
alone  is  left  to  nourish  the  tooth,  a  thing  which  at  best  could  be  but  very 
imperfectly  done,  but  with  an  existing  pyorrhoea  or  the  further  dental 
operation  of  placing  a  crown  which  necessitates  the  grinding  away  of  the 
convex  sides  of  projecting  portions  of  the  teeth,  thus  destroying  many 
living  cells  again,  it  becomes  an  impossibility.  Further  the  snugly  fitting 
crown  causes  a  pressure  necrosis  of  the  underlying  cells.     Infection  in- 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE       51 

variably  occurs  around  such  crowns  and  the  primary  focus  of  possible 
subsequent  systemic  disease  is  planted. 

The  foregoing  is  not  intended  in  any  way  to  reflect  upon  the  technique 
of  the  dentist,  the  sterilization  of  hands  and  instruments,  etc.,  for  I  am 
firmly  convinced  that  this  precaution  is  becoming  general  among  them. 
Likewise  devitalizing  may  be  necessary  for  certain  dental  procedures  now 
in  use,  but  I  trust  the  inexhaustible  ingenuity  of  the  dental  profession 
will  soon  find  a  way  to  do  without  this  method  of  treatment  and  indeed, 
it  is  well  known  that  dentists  abhor  the  full  gold  crown  as  much  as  the 
physicians,  but  find  themselves  compelled  to  use  it  in  order  to  '*save  a 
tooth." 

[The  International  Journal  of  Orthodontia,   November,    19 15] 

Contents 

The  Etiology  and  Treatment  of  Some  Types  of  Deflected  Nasal  Septum.    By  Martin  Dewey, 

D.D.S.,  M.D.,  Kansas  City,  Mo. 
The  History  of  Orthodontia  (Continued).     By  Bernhard  W.  Weinberger,  D.D.S.,  New  York 

City. 
Treatment  of  A  Class  II,  Division  i  Case.    By  W.  G.  Barr,  D.D.S.,  Wichita,  Kas. 
A  Case  History  from  Practice.    By  Hugh  G.  Tanzey  D.D.S.,  Kansas  City,  Mo. 

Current  Orthodontic  Literature 
Some  Infections  of  the  Head  and  Their  Causes.    By  J.  Sheldon  Clark,  M.D..  Freeport,  III. 

Editorials 

Dr.  Stanton's  Instrument  for  Surveying  the  Dental  Arch. 

Some  Disputed  Points  in  Orthodontic  Treatment. 

Dental  and  Medical  Newspaper  and  Magazine  Advertising. 

[The  Western  Dental  Journal,  November,  1915] 

Original  Contributions 

Conductive  Anesthesia.    By  Dr.  Arthur  E.  Smith. 

R6sum6  of  the  Conductive  Anesthesia  Clinic.    By  Dr.  Hinman. 

Ethics  and  Good  Taste.    By  Dr.  C.  C.  Allen. 

[Dominion  Dental  Journal,  November,  1915] 
Contents 

Original  Communications 

Clean  Hands.    By  Jas.  M.  Magee,  D.D.S.,  L.D.S.,  St.  John,  N.B. 
Addresses  of  Welcome,  New  Brunswick  Dental  Society. 
Replies  to  addresses. 


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52  THE  DENTAL  DIGEST 

President's  Address—New  Brunswick  Dental  Association.    By  W.  P.  Bonnell,  D.D.S., 

L.D.S. 
A  Trip  in  War  Times.    By  A.  W.  Thornton,  D.D.S.,  L.D.S.,  Montreal. 

Denial  Societies 

Reports  of  Committees,  New  Brunswick  Dental  Society. 

The  Annual  Convention  of  the  New  Brunswick  Dental  Society. 

Oral  Hygiene  Conference  in  Toronto. 

Toronto  Dental  Society. 

Canadian  Army  Dental  Corps. 

National  Dental  Association. 

Editorial 

*Desensitizing  Dentine  with  Paraform. 

The  Annual  Fee  of  the  Royal  College  of  Dental  Surgeons  of  Ontario. 
Quebec  Again  Refuses  to  Enter  Dominion  Dental  Council. 
Dr.  J.  Burkhart  Appointed. 
Editorial  Notes. 

Selections 


Army  Forms  and  Regimental  Teeth. 
Dental  Treatment  for  the  Troops. 

Reviews 
Alveolodental  Pyorrhea.    By  Chas.  C.  Bass,  M.D. 


Obituary 


The  late  Dr.  Chas.  W.  Brown. 
The  late  Dr.  W.  T.  Stuart. 


DESENSITIZING  DENTINE  WITH  PARAFORM 

Equal  parts  of  paraform  and  cocaine  crystals  were  moistened  to  a 
paste  with  oil  of  cloves  and  applied  to  an  almost  exposed  pulp  of  a  first 
permanent  molar  of  a  child  ten  years  old.  The  pulp  had  to  be  devital- 
ized, so  it  was  first  used  to  try  the  effect  of  cocaine  and  paraform  on  it. 
The  paste  was  sealed  into  the  cavity  with  cement  for  about  a  week.  There 
was  neither  pain  nor  soreness  during  that  time.  When  the  dressing  was 
removed  the  decalcified  dentine  which  had  been  exceedingly  sensitive  was 
readily  excavated  without  pain,  and  the  horns  of  the  pulp  cut  with  free- 
dom, though  the  tissue  was  quite  sensitive  below.  The  same  application 
was  made  in  many  deep  cavities  in  which  there  was  no  pulp  exposure;  in 
very  few  of  these  was  there  the  slightest  discomfort,  and  in  most  cases 
happy  results  on  the  dentine.  In  shallow  cavities  there  is  less  need  of  the 
cocaine  and  greater  difficulty  in  sealing,  so  less  cocaine  may  be  used  and 
more  paraform.    The  proportion  of  cocaine  and  paraform  is  governed 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  UTERATURE       53 

by  the  state  of  the  sensitiveness  of  the  pulp  and  the  nearness  to  it.  The 
length  of  time  to  leave  the  application  is  governed  by  the  amount  brought 
into  actual  contact  with  vital  dentine.  In  shallow  cavities  equal  parts 
of  the  cement  powder  and  paraform  may  be  mixed  with  the  liquid  and 
inserted,  but  if  the  pulp  has  been  irritated  for  any  reason  much  less 
paraform  must  be  used.  If  a  small  amount  of  the  paraform  is  brought 
in  contact  with  the  tooth's  surface,  then  leave  it  even  weeks,  but  on  the 
other  hand  if  a  large  percentage  has  been  brought  in  contact  then  days 
may  suffice.  It  is  wise  to  remove  whatever  decay  possible  before  apply- 
ing, but  if  success  does  not  come  with  one  application  and  there  has  been 
no  irritation  increase  the  percentage  in  another  application.  The  pene- 
tration of  the  drug  is  not  very  deep,  one  or  two  millimeters  is  the  limit, 
and  it  does  not  spread  laterally  more  than  the  anastomosis  of  the  tubules. 
If  it  is  applied  to  one  surface  of  a  tooth  it  won't  desensitize  the  opposite 
surface. 

If  the  profession  will  carefully  test  out  the  value  of  paraform  as  a 
means  of  desensitizing  dentine  and  report  the  results  it  will  not  be  long 
until  its  true  place  will  be  known  to  all.  An  ounce  bottle  of  paraform 
costs  about  thirty  cents.  It  is  a  yellowish-white  crystalline  powder, 
with  a  peculiar  odor.    Try  it. 

[The  Dental  Outlook,  December,  1915] 

Original  Communications 

•Treatment  and  Filling  of  Root  Canals.    By  Dr.  R.  Ottolengui. 
Balanced  Alloys.    By  N.  K.  Garhart. 
Dentistry  and  System.     By  S.  Herder,  D.D.S. 
"Sweatshop  Dentists."    By  Dr.  M.  Schneer. 
The  Dental  Student  and  the  Profession.      By  Morris  Zucker. 
Gateways  of  Infection. 

A  Mother's  Thought  on  the  War.    By  Bert  Ullad. 
Our  Good  Friend,  the  Dentist.    By  Arthur  Brooks  Baker. 
Monthly  Report  of  Legislation  Committee  of  the  Allied  Dental  Council. 
Hold  Man  and  Woman  Practicing  Without  Licenses. 

TREATMENT  AND  FU-LING  OF  ROOT  CANALS 
By  R.  Ottolengui,  New  York 
The  Alternative  for  the  Surgical  Treatment  of  Root  Ends  is  Ionization 

The  action  of  the  electric  current  in  an  electrolyte  is  to  split  it  up 
chemically  into  simpler  materials  which  move  to  their  respective  elec- 
trodes. These  materials  are  called  ions.  The  ion  is  the  conveyor  of 
electricity;  hence  the  ion  which  travels  to  the  anode  is  called  the  anion, 
and  the  ion  which  goes  to  the  cathode  is  called  the  cation.     The  use  of 


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54  THE  DENTAL  DIGEST 

medicaments  by  ionization  has  been  much  more  studied  abroad  than  by 
American  dentists.  Clinical  results  are  sufficiently  satisfactory  to 
make  it  highly  probable  that  in  the  ionization  of  tissues  through  the 
canals  of  teeth  we  have  a  very  promising  method  of  controlling  even 
serious  infectious  conditions. 

Abroad  the  method  employed  mainly  is  to  use  a  platinum  point  as 
the  anode,  and  to  flood  the  canal  with  chloride  of  zinc.  The  method 
advocated  by  Rhein  and  others  in  this  country,  and  thus  far  the  only 
method  tested  by  myself,  is  to  use  an  anode  of  pure  zinc  and  to  flood  the 
canal  with  normal  salt  solution.  When  a  current  is  passed  through  an 
electrolyte  containing  a  salt  in  solution  the  metals,  or  metallic  radicals 
move  from  the  anode  to  the  cathode;  thus  by  using  the  zinc  point  as  the 
anode,  the  ions  pass  from  the  zinc  through  the  apical  foramen  and  act 
upon  the  tissues  about  and  beyond  the  apex. 

Tests  out  of  the  mouth  easily  demonstrate  that  the  result,  say  upon  a 
bit  of  beef,  is  much  the  same  as  where  chloride  of  zinc  is  used;  markedly 
escharotic.  In  twenty  minutes  a  cubic  quarter  inch  of  fresh  beef  may 
thus  be  so  disintegrated  by  ionization  that  it  can  be  easily  macerated  be- 
tween the  thumb  and  the  forefinger.  Hence  if  a  true  granuloma  be 
present  in  the  apical  space,  caused  by  septic  infection,  this  granuloma 
may  thus  be  destroyed,  and  the  theory  is  that  it  is  then  absorbed  and 
slowly  replaced  by  normal  tissue. 

It  is  also  claimed  that  ionization  with  the  zinc  used  in  combinaton 
with  normal  salt,  will  sterilize  dentine  and  cementum,  as  well  as  the  tissues 
about  and  beyond  the  apical  foramen. 

[The  Texas  Dental  Journal,  November,  1915] 

Original  Communications 

Some  Practical  Points. 

Thirty-first  Annual  Convention  of  the  Texas  State  Dental  Association. 

Professional  Ethics. 

Dental  Radiography. 

Taking  Impressions. 

[The  Pacific  Dental  Gazette,  November,  1915] 
Contents 

Original  Articles 

Local  Anesthesia  in  Dental  Surgery.    By  Otteson. 
A  Symposium  on  the  Ameba  Buccal  is.     By  Gray. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE       55 

Editorial 
A  Pedagogic  Duty  or  a  Necessity? 

Reviews  of  Domestic  and  Foreign  Dental  Literature 

Mouth  Hygiene. 

Selections 

The  Significance  to  the  Dentist  of  Oral  Infections  in  Their  Relation  to  Systemic  Disorders. 

By  Gibner. 
The  Relation  of  the  Internal  Secretory  Organs  to  Malocclusion,  Facial  Deformity,  and  Dental 

Disease.    By  Grieves. 


Mercurial  Stomatitis. 


Reminiscences  by  Dr.  Asay. 


Dental  Excerpts 
Special  Article 


[Oral  Health,  November,  1915] 

Photograph,  Major  A.  A.  Smith,  Acting  Chief  Dental  Surgeon,  C.A.D.C. 
*The  Progress  of  the  Research  Commission  of  the  National  Dental  Association.    By  Weston 

A.  Price,  D.D.S.,  M.S.,  Cleveland. 
Six  Years  of  X-Ray  in  Dentistry.    By  Stephen  Palmer,  D.D.S.,  Poughkeepsie. 
Quarterly  Report,  Canadian  Army  Dental  Corps. 
Society  Announcements. 

Summary  of  Dental  Laws  of  Canadian  Provinces. 
The  Compendium. 
The  Active  Service  Roll. 
Multum  in  Parvo. 
Editorial. 

THE  PROGRESS  OF  THE  RESEARCH  COMMISSION  OF  THE  NATION.AL  DENTAL 

ASSOCIATION 

By  Weston  A.  PiacE,  D.D.S.,  M.S.,  Cleveland,  Ohio 

The  research  department  is  giving  support  to  the  solving  of  metal- 
lurgical problems,  and  I  think  I  am  justified  in  telling  you  that  one 
third  of  the  platinum  used  in  the  world  is  used  in  the  practice  and  art  of 
dentistry,  and  do  you  realize  that  for  the  dental  profession  it  amounts 
to  $2,500,000  annually?  If  we  would  utilize  the  opportunity  and  the 
information  we  have  on  the  tungsten  product  which  has  been  developed 
through  our  Research  Commission,  it  would  result  in  great  benefit  and 
good  to  the  dental  profession.  This  metal  is  six  times  as  strong  as  iridio- 
platinum;  it  has  a  melting  point  nearly  twice  as  high  as  that  of  platinum ; 
its  elasticity  is  twice  as  great  as  that  of  steel.     It  has  a  hardness  so  much 


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56  THE  DENTAL  DIGEST 

greater  than  that  of  steel  that  the  management  of  the  General  Electric 
Company  is  responsible  for  the  statement  that  one  tungsten  point  will 
outwear  two  hundred  steel  points.  It  is  a  metal  that  does  not  lose  its 
elasticity  when  you  heat  it.  This  metal  is  available  for  any  man  in  this 
room  for  use  in  making  posts  for  crowns  and  for  casting  bridges  upon. 
It  is  so  stiff  and  rigid  that  you  can  make  a  framework  of  it  and  cast  about 
it  and  control  the  contraction  that  will  take  place  in  casting  a  bridge  with 
its  abutments,  all  at  the  same  time.  You  may  use  it  for  orthodontia 
appliances  either  by  the  method  which  has  been  presented  by  Dr.  Robin- 
son or  by  the  standard  methods. 

Relative  to  the  application  of  the  metal  in  orthodontia  appliances, 
I  am  advised  that  it  is  destined  to  supplant  largely  the  metals  that  are 
in  use  up  to  this  time  for  orthodontic  work.  With  its  greater  elasticity, 
you  can  make  attachments  to  it  with  hard  gold  solder.  It  has  the 
property  of  enormous  strength;  it  does  not  break  off  like  clasp  metal 
wires  by  crystallization.  You  m^y  use  wire  that  is  so  much  smaller 
that  it  seems  incredible  for  it  to  accomplish  the  work  it  does. 

Any  dentist  who  will  write  to  the  commission  can  get  the  metal.  We 
are  furnishing  it  to  the  profession  at  what  it  costs  us  to  produce  it, 
and  ultimately  the  manufacturers  will  make  it.  The  selling  price  is 
virtually  one  sixth  of  that  of  platinum  for  the  same  weight. 

In  the  last  two  or  three  months  our  research  department  has  been 
able  to  furnish  the  profession  enough  tungsten  to  supplant  the  use  of 
platinum  to  go  far  toward  paying  for  the  research  expense  that  the  com- 
mission has  gone  to  for  that  particular  line  of  research  work.     (Applause.) 

There  are  only  a  few  who  know  about  it,  because  you  have  not  read 
the  recent  issues  of  the  Journal  of  the  National  Dental  Association  with 
reference  to  the  research  work  we  have  been  doing  in  regard  to  this  metal. 

As  to  palladium,  it  requires  no  special  preparation.  Any  man  can 
send  to  the  American  Platinum  Works,  New  Jersey,  and  buy  palladium 
for  $48  an  ounce.  You  can  get  twice  the  bulk  for  the  same  weight  that 
you  can  with  platinum.  You  can  make  it  equivalent  to  platinum  at 
$26  an  ounce. 

{British  Dental  Journal,  November  i,  191 5] 

Contents 

Original  Communications 

A  Review  of  Recent  Researches  concerning  the  Nature  of  Dental  Caries.    By  W.  H. 
Jones  (Downing  College,  Cambridge),  B.  A.  Cantab.,  L.D.S.,  Eng. 
*  Presidential  Inaugural  Address. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE      57 

Selected  Article 
"  Diagnosis  of  Ulcers  of  the  Tongue."    By  E.  C.  Hughes,  M.C.,  F.R.C.S. 

Editorial 
•Annual  Report  of  Chief  Medical  Officer,  Board  of  Education,  for  1914. 

News  and  Comments 

Lord  Derby's  Appeal. 
The  War. 

Contents  of  this  Number. 
The  National  Insurance  Act. 
The  Royal  Dental  Hospital. 
The  Dental  Curriculum. 
Christmas-in-Wartime  Sale. 
Chronic  Cervical  Adenitis. 

The  Dental  Profession  and  the  War 

Four  Brothers. 

Second-Lieutenant  R.  H.  Basker,  L.D.S.,  Killed  in  Action. 

Exhibition  or  Fracture  Apparatus  at  the  Royal  Society  of  Medicine. 

A  Prophylactic  Interdental  Splint. 

Professor  Dr.  Dependorf  killed. 

Germany's  Need  of  Dentists. 

Dundee  Dental  Hospital. 

Current  Dental  Literature. 

PRESIDENTIAL  INAUGURAL  ADDRESS* 
By  Reginald  E.  Bascombe,  L.D.S.,  Eng. 

Each  day  we  notice  the  slow  but  sure  progress  that  is  being  made, 
and  this  war  has  already  done  more  than  the  last  decade  of  peace  to  teach 
a  great  national  lesson — that  "the  care  of  the  teeth'*  is  the  very  hypo- 
thesis upon  which  health,  strength,  the  power  to  endure,  the  length  of 
life  itself  wholly  and  entirely  depend.  So,  out  of  evil  comes  good;  the 
powers  that  be  have  discovered  in  a  time  of  stress  that  this  war  will  be  a 
true  case  of  survival  of  the  fittest,  that  half  the  troubles  of  the  soldier 
are  due  to  want  of  knowledge,  that  the  care  of  the  teeth  comes  before  all 
else;  and  so  with  feverish  haste  nearly  three  millions  of  men  are  being 
put  under  the  skilful  treatment  of  the  specialist.  Here  let  me  remark  in 
parenthesis  that  it  is  the  duty  of  every  qualified  practitioner,  while 
doing  his  utmost  for  the  men  who  go  forth  to  save  our  homes,  at  the 
same  time  to  teach  each  man  with  care  and  patience  the  necessity  for 
constant  cleanliness  and  annual  supervision  at  the  hands  of  the  qualified 
dentist. 

These  common  soldiers  are  for  the  most  part  splendid   men   with 

•Delivered  before  the  Eastern  counties  Branch  at  Bury  St.  Edmund's  on  September  24, 1915. 

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58  THB  DENTAL  DIGEST 

hearts  of  gold,  and  I  have  been  overwhelmed  by  the  tokens  of  gratitude 
which  I  have  received  at  their  hands.  So  many  men  have  spoken  of 
their  gratitude  to  the  Government  which  has  enabled  their  eyes  to  be 
opened,  and  oft  I  have  heard  it  said,  "If  only  my  parents  had  taught  me 
to  clean  my  teeth!  I  thought,  indeed,  that  dentists  were  only  to  remove 
teeth  when  at  last  they  became  unbearable  by  reason  of  the  pain  they 
gave!*'  So  here  is  a  boon  to  mankind;  the  hour  of  peril  has  caused  the 
slow-geared  cogs  of  evolution  to  leap  forward  half  a  century.  These  men 
will  never  forget,  and  they  will  see  that  their  children  profit  by  the  lessons 
which  they  are  being  taught  to-day.  Mr.  Bailey  is  a  man  who  gave 
his  all  freely  to  help  in  the  great  fight  to  enable  our  profession  to  take  that 
high  position  which  it  has  earned  for  itself  by  self-sacrificing  endeavor. 
He  deserves  our  gratitude  for  his  honest  convictions  as  to  the  necessity 
of  systematic  dental  treatment  for  the  poor.  The  fervor  for  the  cause 
he  has  inspired  by  his  efforts  is  echoed  in  the  clinics  we  see  springing  up 
around  us. 

ANNUAL    REPORT    OF    CHIEF    MEDICAL    OFFICER,    BOARD    OF    EDUCATION 

FOR    19 14 

In  regard  to  the  Dental  Treatment  Scheme,  130  areas  are  now  sanc- 
tioned, as  compared  with  88  in  the  preceding  year,  and  that  no  fewer  than 
195  organized  dental  clinics  now  exist,  as  compared  with  150  in  the  pre- 
ceding year.  The  number  of  dentists  employed  was  approximately  200, 
of  whom  but  51  were  full-time  officers.  The  report  calculates  that  the 
provision  is  sufficient  to  undertake  the  treatment  of  37s, 000  children.  In 
London  alone  upward  of  42,000  children  are  now  provided  for  annually, 
an  increase  of  nearly  11,000  as  compared  with  the  preceding  year,  and 
this  in  spite  of  war  difficulties. 

Over  and  above  the  ordinary  stationary  dental  clinics,  "traveling 
clinics"  have  been  instituted  in  Devon,  Norfolk,  and  the  West  Riding 
of  Yorkshire;  in  Norfolk  the  dental  work  is  actually  carried  out  in  a 
dental  caravan,  though  to  our  disappointment  little  is  said  as  to  whether 
this  plan  is  a  success  or  not.  In  Devonshire  and  the  West  Riding  of 
Yorkshire  the  dental  equipment  is  carried  from  place  to  place. 

[British  Dental  Journal,  November  15,  1915] 

Original  Communications 

A  Review  of  Recent  Researches  concerning  the  Nature  of  Dental  Caries.    By  W.  H.  Jones 

(Downing  College,  Cambridge),  B.  A.  Cantab.,  L.D.S.,  Eng. 
Surgical  Prosthesis  of  the  Jaws.    By  H.  Watson  Turner,  M.R.C.S.,  L.R.C.P.,  L.D.S. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE       59 

Editorial 
"On  Surgical  Prosthesis." 

News  and  Comments 

Dentists  and  Lord  Derby's  Recruiting  Appeal. 
Contents  of  this  Number. 
The  R.  C.  S.  Museum  Demonstrations. 
To  Photographers. 
L.  C.  C.  Economies. 

A  Medical  Officer  on  Unqualified  Practice. 
Tokyo  Dental  College. 
^Russian  Women  Dentists. 

The  Dental  Profession  and  the  War 

Dental  Pupil  Killed  in  Action. 

The  Kaiser's  Dentist. 

Dental  Student  Promoted. 

House  of  Commons — Answers  to  Questions. 

The  Case  of  Dental  Students. 

The  Position  of  Dentists  at  War  Hospitals. 

Dentistry  for  the  Troops  at  Doncaster. 

Dentists'  War  Relief  Fund. 

RUSSIAN  WOMEN  DENTISTS 

In  view  of  our  growing  interest  in  Russian  affairs,  a  note  on  dental 
conditions  in  that  great  Empire  may  be  opportune.  In  Russia  dentistry 
is  regarded  as  one  of  the  best  professions  for  women,  who  are  estimated 
to  constitute  90  per  cent,  of  dental  practitioners.  The  chief  school  is  the 
Dental  College  at  Petrograd,  which  has  600  students,  less  than  5  per 
cent,  of  whom  are  men.  There  are  also  large  dental  colleges  at  Moscow, 
Odessa,  Kiev,  and  Warsaw.  Before  entering  upon  the  three  years' 
dental  course  the  student  is  required  to  have  matriculated.  The  fees 
amount  to  £20  per  year  and  the  State  diploma  costs  £2,  a  license  to 
practise  being  only  granted  on  proof  of  qualification.  The  first  year's 
studies  are  devoted  to  mechanical  dentistry;  in  subsequent  years  the 
student  does  clinical  work  from  10  to  5,  and  lectures  follow  until  9  p.m. 
Examinations  are  held  every  month.  The  lecturers  at  Petrograd  num- 
ber about  twelve  and  come  from  the  Imperial  University  Faculty  of 
Medicine,  while  the  ten  demonstrators  are  chiefly  women.  For  both 
medicine  and  dentistry  fees  in  Russia  are  considerably  lower  than  in  this 
coimtry,  and  hours  of  work  are  also  longer.  Men  seem  to  prefer  to  enter 
the  medical  profession,  and  it  is  said  that  even  in  the  capital  city  of 
Petrograd  the  men  dentists  of  standing  do  not  number  more  than  half- 
a-dozen. 


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60  THE  DENTAL  DIGEST 

[New  York  Medical  Journal,  November  27,  iQisl 
REMEDIABLE  DEFECTS  IN  SCHOOL  CHILDREN 

Supplement  No.  25  to  the  Public  Health  Reports  for  July  30,  1915, 
consists  of  a  study  of  school  hygiene  in  Manatee  County,  Fla.,  by  Surgeon 
J.  A.  Nydegger.  After  describing  the  country,  the  school  buildings, 
their  environment,  drainage,  outhouses,  drinking  and  lighting  facilities, 
ventilation,  etc.,  the  writer  takes  up  the  health  of  the  children.  Apart 
from  trachoma,  the  treatment  of  which  requires  great  care  and  patience, 
together  with  the  personal  attention  of  the  surgeon,  the  principal  troubles 
found  were  adenoids,  enlarged  tonsils,  defective  teeth,  and  hookworm. 
The  writer  points  out  that  the  special  object  of  his  survey  was  to  investi- 
gate communicable  disease,  but  that  other  conditions  were  also  studied, 
including  ground  itch,  deformities  of  the  back  and  limbs,  defective  vision 
and  hearing,  poor  physique,  dullness  and  backwardness,  etc. 

In  the  1,684  school  children  examined,  says  Surgeon  Nydegger  in  his 
report,  426  or  26.03  P^r  cent.,  had  defective  teeth,  ranging  from  a  single 
tooth  to  three  or  four  or  more.  A  condition  of  the  teeth  noted  to  exist 
in  the  children  of  several  schools,  but  mostly  in  the  town  schools,  was  the 
loss  of  the  enamel  from  a  portion  of  the  surface  of  one  tooth  or  several 
teeth  in  one  individual.  In  some  cases  the  enamel  was  noticed  to  have 
disappeared  from  the  entire  biting  surfaces,  while  in  others  it  was  de- 
stroyed elsewhere.  It  is  believed  that  this  condition  results  from  the 
prolonged  action  of  acids  on  the  teeth,  such  as  would  be  brought  about 
largely  by  the  consumption  of  oranges  and  grape  fruit,  extending  over  a 
long  period.  The  good  result  of  dental  inspection  of  school  children  was 
well  exhibited  in  the  Sarasota  schools,  where  it  was  instituted  during  the 
present  year.  In  the  279  children  examined  at  the  time  of  the  visit  but 
one  case  of  defective  teeth  was  discovered.  This  is  in  decided  contrast 
with  the  findings  at  the  Palmetto  schools,  which  showed  22  per  cent, 
of  the  children  to  be  suffering  from  defective  teeth.  It  would  have 
been  interesting  to  have  had  a  special  note  on  the  teeth  of  colored 
children. 

Two  hundred  and  seventy-four  children,  or  16.2  per  cent.,  had  en- 
larged tonsils,  while  164  children,  or  9  per  cent.,  had  adenoids.  There 
was  a  noticeable  difference  in  the  proportion  of  enlarged  tonsils  observed 
in  school  children  in  towns  from  those  in  the  rural  schools,  in  favor  of  the 
latter.  The  children  examined  in  the  colored  schools,  numbering  243, 
were  noted  to  be  particularly  exempt  from  enlarged  tonsils  and  adenoids. 
Two  hundred  and  thirty- three  children,  or  13.24  per  cent,  of  the  total 
number  examined,  had  adenoids.  The  figures  show  a  preponderance  of 
5.6  per  cent,  more  cases  in  the  town  schools  than  in  the  county  schools. 

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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     61 

In  243  children  examined  in  the  two  colored  schools  there  were  13  cases, 
or  5.3  per  cent. 

We  have  found  this  report  on  adenoids,  enlarged  tonsils,  and  de- 
fective teeth  of  special  interest  because  these  conditions  would  never  be 
met  with  by  a  medical  inspector  if  the  general  intelligence  of  the  com- 
munity was  what  it  should  be.  It  seems  to  us  that  the  dentists  and  phy- 
sicians in  various  parts  of  the  country  should  organize  some  sort  of  an 
educational  campaign,  having  for  its  object  the  bringing  of  the  children 
for  inspection  every  six  months  or  so.  Oral  and  pharyngeal  lesions  have 
a  direct  bearing  on  the  nutrition  and  growth  of  the  child  and  the  treat- 
ment should  really  be  prophylactic  only  and  begin  at  the  time  of  weaning. 
Surgeon  Nydegger's  best  impressions  of  his  survey,  however,  were  con- 
veyed by  the  joyous,  laughing,  romping  assemblages  of  happy  school 
children  encountered  at  each  school  visited,  which  of  itself  was  proof 
sufficient  of  generally  well  nourished  and  vigorous  bodies.  It  was  a 
real  treat,  he  says,  to  mingle  with  these  alert  and  vivacious  young  Ameri- 
cans, so  intent  on  catching  each  word  spoken  to  them. 

ACADEMIC  FREEDOM 

In  his  annual  report  to  the  trustees  of  Columbia  University,  President 
Nicholas  Murray  Butler  tells  of  numerous  criticisms  of  public  utterances 
of  members  of  the  faculty  which  have  reached  him  from  outside  the 
university.  These  criticisms  are,  as  a  rule,  based  on  incorrect  or  garbled 
reports  of  what  the  professor  really  said,  or  indicate  a  desire  on  the  part 
of  the  critic  to  use  the  university  as  a  medium  for  some  particular  propa- 
ganda. The  critic  usually  demands  the  instant  removal  of  the  offending 
faculty  member  from  the  roll  of  the  imiversity. 

In  conmienting  on  this  regrettable  attitude.  Professor  Butler  wisely 
says:  "The  last  thing  that  many  persons  want  is  freedom  of  speech  or 
of  anything  else  unless  its  exercise  happens  to  accord  with  their  somewhat 
violent  and  passionate  predilections." 

There  is  a  tendency  in  medicine  toward  the  same  kind  of  criticism  as 
that  complained  of  by  President  Butler,  and  in  medical  publications  we 
must  carefully  conserve  freedom  of  speech  and  of  views  if  we  expect  to 
make  progress.  We  must,  above  all  else,  avoid  the  suppression  of  truth 
through  the  exercise  of  the  "somewhat  violent  and  passionate  pre- 
dilections "  of  those  who  would  limit  the  freedom  of  speech  in  medicine 
within  the  compass  of  their  own  narrow  knowledge  and  sympathies. 

[Journal  American  Medical  Association,  November  13,  1915] 
THE  LOCALIZATION  OF  STREPTOCOCCI 

The  relation  to  infection  of  the  affinity  of  bacteria  for  certain  tissues 


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62  THB  DBNTAL  DIGEST 

was  discussed  recently  in  these  columns.^  It  was  pointed  out  that  many 
of  the  pathogenic  bacteria  in  their  localization  manifest  a  special  affinity 
for  some  particular  tissue  or  tissues.  This  elective  localization  may  be 
conceived  to  be  due  to  the  circumstance  that  the  conditions  for  growth 
are  more  favorable  in  some  tissues  than  in  others.  On  account  of 
differences  in  metabolism  and  chemical  composition,  there  is  no  doubt 
that  different  tissues  and  places  in  the  body  present  radically  different 
conditions  for  bacterial  growth  and  activity.  It  was  pointed  out,  further, 
that  the  work  of  Forssner  and  especially  the  more  recent  work  of  Rose- 
now  have  established  that  among  the  streptococci,  which  have  the  power 
to  invade  many  tissues  and  to  cause  a  variety  of  infections,  strains  may 
appear  which,  when  introduced  into  the  blood,  are  found  to  localize  by 
preference  in  certain  tissues.  It  his  article  in  this  issue  of  The  Journal^ 
Rosenow^  presents  a  summary  of  the  results  of  his  experiments  of  elective 
localization  of  streptococci  obtained  from  a  wide  range  of  human  infec- 
tions and  injected  intravenously  into  dogs  and  rabbits.  The  animals 
were  killed  soon  after  the  injection,  and  the  facts  as  to  localization  of  the 
streptococci  determined  by  systematic,  careful  examination  of  the  whole 
body.  Obviously  this  method  gives  a  much  better  idea  of  early  localiza- 
tion than  can  be  obtained  if  only  the  animals  that  die  are  examined. 

Stated  in  the  simplest  way,  the  results  obtained  by  Rosenow  with  his 
method  show  (i)  that  streptococci  isolated  from  active  lesions  in  different 
human  organs  and  tissues,  in  many  instances,  have  a  pronounced  affinity 
for  the  corresponding  organs  and  tissues  in  rabbits  and  dogs,  and  (2)  that 
streptococci  isolated  from  the  tonsils  and  pyorrheal  pockets  in  persons 
with  active  streptococcal  infection  in  the  interior  of  the  body  may  have 
the  same  sort  of  affinities  as  the  streptococci  from  the  internal  lesions. 
In  the  light  of  these  results,  many  of  which  are  striking  indeed,  as  may  be 
seen  at  a  glance  from  the  table  in  Rosenow*s  article,  human  strepto- 
coccus infections  acquire  new  interest  because  a  road  now  opens  to  a 
better  understanding  of  their  genesis  and  of  the  difficulties  of  curing  them 
by  the  specific  means  now  in  use.  Obviously  a  chief  danger  from  chronic 
foci  in  which  streptococci  are  present,  of  which  those  in  the  tonsils  and 
about  the  teeth  appear  to  be  the  most  important  because  the  most  com- 
mon, seems  to  depend  on  the  fact  that  in  such  foci,  even  when  quiescent, 
streptococci  may  get  into  biochemical  conditions  which  fit  them  for  in- 
vasion of  the  blood,  to  be  followed  by  localization  in  some  tissues  rather 
than  in  others.     Persons  going  about  with  chronic,  more  or  less  latent 

'The  Relation  of  Selective  Tissue  Affinity  to  Infection,  editorial,  The  Journal  A.  M.  A., 
Sept.  26,  1915,  p.  1 1 14. 

*Rosenow,  E.  C:  Elective  Localization  of  Streptococci,  The  Journal  A.  M,  ^4.,  this 
issue,  p.  1687. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    63 

fod  of  this  character,  consequently,  are  not  only  dangerous  to  themselves 
in  that  what  one  may  call  internal  streptococcal  metastasis  may  occur  at 
any  time,  but  they  are  also  undoubtedly  dangerous  to  others  because 
they  scatter  about  them  streptococci  of  specialized  pathogenic  possi- 
bilities. Hence  the  efforts  now  made  to  detect  and  then  to  obliterate 
all  forms  of  focal  infection  in  the  mouth  and  throat  as  well  as  elsewhere 
in  the  body,  for  preventive  as  well  as  curative  purposes,  besides  being  in 
accord  with  sound  reasoning  from  general  principles,  here  receive  the 
support  also  of  strong  experimental  evidence.  When  we  consider  the 
wide  range  of  action  of  pathogenic  streptococci,  the  great  variety  of 
disease  due  to  their  localizations  in  different  tissues  according  to  what 
Rosenow's  work  indicates  are  states  of  special  "elective  aflBmities,"  no 
effort  should  be  spared  that  in  any  way  will  tend  to  reduce  the  supply  of 
such  streptococci  and  lessen  the  chance  of  infection. 

PYORRHEA  DUE  TO  ORGANISMS  OTHER  THAN  THE  AMEBAS 
By  George  Howard  Hoxie,  A.M.,  M.D.,  Kansas  City,  Mo. 

Since  the  publication  of  the  work  of  Bass  and  Johns  on  pyorrhea, 
there  has  seemed  to  be  a  tendency  among  dentists  and  many  medical 
men  to  administer  emetin  in  all  cases  of  dental  infections  without  estab- 
lishing the  presence  of  the  endameba.  That  the  endameba  is  not  the 
cause  of  all  cases  diagnosed  as  pyorrhea  by  competent  dentists  is  shown 
by  this  following  summary  of  a  case  treated  by  this  author. 

W2  have  to  do  with  a  recurrent  fever  of  about  seventeen  days'  dura- 
tion. The  focus  has  been  the  alveolar  processes  and  the  mucosa  of  the 
mouth,  from  which  the  body  has  been  invaded.  The  particular  parts, 
aside  from  the  mouth,  which  have  shown  evidences  of  infection,  have 
been  the  left  knee  (bursitis)  and  the  anal  fold  (abscesses).  The  length 
of  the  attacks  has  varied  from  three  to  ten  days.  The  organisms  most 
constantly  found  have  been  a  diplo-streptococcus  and  a  mold.  The 
disease  has  proved  resistant  to  arsenic  (salvarsan,  arsacetin  and  the  tri- 
oxid),  the  salicylates  and  other  systemic  and  local  germicides,  as  well  as 
to  vaccines,  both  autogenous  and  stock,  single,  as  well  as  mixed. 

The  question  of  great  interest  is  whether  we  have  to  do  with  an 
organism  showing  a  cycle  of  from  fourteen  to  seventeen  days,  or  whether 
it  is  a  case  of  temporary  immunity.  Repeated  examinations  have  failed 
to  reveal  any  amebas.    Animal  inoculation  was  negative. 

To  me  it  would  appear  that  the  causative  organism  is  one  which  is 
ordinarily  nonpathogenic,  but  which  has  acquired  parasitic  power  in  the 
tissues  of  this  patient. 

It  is  perhaps  needless  to  say  that  all  the  conventional  drugs  have  been 
used  at  one  time  or  another  by  the  various  physicians  who  have  treated 


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64  THE  DBNTAL  DIGEST 

the  patient.  The  dentists  employed  have  been  the  best  in  the  dty.  The 
case  was  worked  up  from  the  dermatologic  standpoint  by  Dr.  R.  L.  Sut- 
ton, and  published  under  the  caption  ''Periadenitis  Mucosa  Necrotica 
Recurrens."  The  diagnosis  of  pyorrhea  was  given  by  all  the  dental 
attendants,  including  Dr.  Frederick  Hecker,  the  author  of  a  monograph 
on  that  subject. 
1334  RiALTO  Building. 

[Deuisches  Archiv.  fur  Klinische  Medizin,  Leipsig,  July  20] 
MECHANISM  OF  INJURY  FROM  GETTING  CHILLED 

Auf recht  presents  an  imposing  array  of  testimony  culled  from  old  and 
modem  writers  to  reaffirm  the  important  part  played  by  getting  chilled 
in  the  genesis  of  various  diseases  and  morbid  processes.  He  then  reports 
various  experiments  on  rabbits,  all  of  which  confirms  his  assumption 
that  the  chilling  causes  coagulation  of  fibrin  in  the  blood  stream  in  the 
part  chilled.  The  cause  of  the  coagulation  is  the  injury  done  to  the 
white  corpuscles  by  the  cold.  The  coagulation  obstructs  the  flow  through 
the  peripheral  vessels  involved  and  the  blood  is  liable  to  back  up  into  the 
liver,  kidneys,  and  gastric  mucosa.  The  most  striking  changes  were 
found  in  the  lungs,  the  coagulation  of  fibrin  entailing  microscopic  hem- 
orrhage into  the  interstitial  tissue.  This  occurred  in  a  pronounced  form 
when  the  hind  part  of  the  rabbit  was  thrice  dipped  into  ice  water  for  ten 
minutes.  The  blood  chilled  in  this  way  passes  in  the  directest  way  to  the 
arterial  circulation  in  the  lungs.  The  obstruction  of  vessels  by  the  coagu- 
lated fibrin  after  chilling  may  be  transitory  and  harmless,  but,  on  the  other 
hand,  it  may  provide  a  culture  medium  for  germs  and  explain  pneu- 
monia developing  after  exposure  to  cold.  The  hyperemia  in  the  internal 
organs  may  also  cooperate  in  the  disturbances  following  chilling. 

[Journal  American  Medical  Association,  November  20,  191 5] 

[Berliner  Klinische  Wochenschrift,  October  11] 
CANCER  OF  THE  MOUTH  AND  RADIUM  TREATMENT 

Sticker  reports  fifteen  cases  in  most  of  which  malignant  disease  of 
the  mouth  retrogressed  under  radium  treatment  without  scars  or  mutila- 
tion. The  list  includes  some  cases  of  recurrence  after  operations.  He 
declares  further  that  radiotherapy  is  preferable  to  surgical  treatment  in 
many  cases  for  technical  reasons  and  also  from  the  standpoint  of  im- 
munity. This  statement  is  based  on  experimental  research  which  demon- 
strated that  it  is  possible  to  induce  an  implantation  tumor  on  laboratory 


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AN  EPITOMB  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     65 

animals  in  various  different  organs  and  points,  inoculated  all  at  the  same 
time,  but  that,  after  having  been  once  successfully  inoculated,  it  is 
impossible  to  induce  further  growths  by  later  implantation  of  tumor  cells 
at  any  point.  After  complete  excision  of  the  implantation  tumor,  how- 
ever, a  new  implant  "takes"  at  any  and  every  point  inoculated  all  at  the 
same  time.  On  the  other  hand,  if  the  implantation  tumor  was  only 
partly  excised  and  it  continued  to  grow,  subsequent  implantations  gave 
constantly  negative  results.  These  experimental  data  correspond  to  what 
is  observed  in  the  clinic  during  the  period  preceding  metastasis.  The 
cancer  long  remains  solitary,  and,  especially  with  cancer  in  mucous  mem- 
branes, notwithstanding  the  constant  opportunities  for  implantation  of 
tumor  cells  farther  along,  the  mucosa  beyond  is  generally  free  from 
metastases,  even  with  extensive  ulceration.  After  vaginal  hysterectomy 
for  cancer  of  the  uterus,  he  continues,  recurrence  in  the  vagina  is  not 
uncommon,  while  metastases  in  the  vagina,  with  the  uterine  cancer  still 
present,  are  extremely  rare. 

These  and  similar  data  cited  are  alleged  to  explain  why  radiotherapy  is 
more  promising  in  certain  cases  than  surgical  removal  of  the  focus. 
Under  the  radiotherapy,  the  cancer  cells  being  gradually  destroyed  and 
passing  into  the  circulation,  cause  a  lively  production  of  antibodies,  and 
these  protecting  substances  combat  the  growth  of  any  new  cancer  cells. 
The  antibodies  thus  generated  are  similar  in  nature  to  the  autolysates  of 
cancer  cells  which  some  are  using  now  in  treatment  of  cancer.  None  of 
the  experiences  in  this  line  reported  to  date,  however,  make  the  distinc- 
tion which  he  emphasizes  between  the  periods  before  and  during  meta- 
stasis. The  nonheeding  of  this  fundamental  distinction  readily  explains 
the  unsatisfactory  results  to  date.  It  is  by  no  means  immaterial  whether 
the  tumor  autolysates  are  taken  from  the  body  while  it  is  still  engaged  in 
producing  antibodies,  that  is,  during  the  premetastasis  stage,  or  whether 
the  material  is  not  taken  until  after  the  body  has  lost  its  capacity  for 
antibody  production. 

He  describes  his  fifteen  cases  in  detail;  in  three  the  cancer  was  on  the 
tongue  and  the  radium  induced  a  clinical  cure.  In  one  case,  only  seven 
twelve-hour  exposures,  all  at  night,  accomplished  the  purpose,  the  cancer- 
ous crater  healing  completely  in  a  few  weeks.  In  seven  cases  the  cancer 
was  in  the  lower  jaw  and  in  five  others  in  the  upper  jaw.  The  radium  was 
fastened  in  a  plate  made  to  fit  over  the  upper  or  lower  teeth.  One  patient 
wore  this  for  thirty  nights'  exposures,  and  it  did  not  interfere  with  his 
sleep.  In  two  other  cases  the  cancer  was  a  recurrence  after  one  or  several 
operations.  By  modifying  the  tooth-plate-holder  it  was  possible  to 
apply  the  rays  in  various  directions  thus  facilitating  the  cure. 


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Simplex  Hand  Book  of  Dental  Materia  Medica  and  Therapeutics. 
By  Alfred  and  Wesley  Barrett.  Oblong  i6mo.  350  pages. 
Price,  $1.75  net.     Publisher,  Peter  Reilly,  Philadelphia,  Pa. 

A  simple,  tabulated  classification  of  Drugs  and  Remedies  used  in 
Dental  Operations  and  the  Treatment  of  Dental  Diseases;  specially 
adapted  to  the  requirements  of  students  and  busy  practitioners. 

A  great  mass  of  facts  are  brought  together  in  alphabetical  order 
which  will  be  appreciated  and  save  valuable  time  in  making  reference. 

The  authors  have  spared  no  pains  in  endeavoring  to  make  this  the 
best  work  of  its  kind. 


BOOKS  RECEIVED 

Carnegie  Endowment  for  International  Peace,  Division  of  Inter- 
course and  Education,  Publication  No.  7.  For  Better  Relations 
With  Our  Latin  American  Neighbors.  A  Journey  to  South 
America.    By  Robert  Bacon,  Washington,  D.  C. 

Carnegie  Endowment  for  International  Peace,  Founded  Decem- 
ber 14,  1910.    Year  Book  for  19JS,  Washington,  D.  C. 


DR.  DWIGHT  TRACY 

Dr.  Dwight  Tracy  died  November  7,  191 5.     He  was  well  known  in 
New  York  City  and  was  most  successful  in  his  profession. 
Dr.  Tracy  leaves  a  son  who  is  also  a  dentist  of  note. 

A.  STILL  WELL 

Mr.  A.  Stillwell,  a  valued  employee  of  The  Temple-Pattison  Co.,  Ltd., 
Ont.,  Canada,  died  Friday  November  26th,  191 5  after  a  very  painful 
illness. 

He  was  a  man  who  took  a  great  interest  in  the  welfare  of  the  dentist, 
and  was  the  oldest  dental  salesman  in  the  Dominion  of  Canada.  He 
was  connected  with  the  old  firm  of  the  S.  B.  Chandler  Co.,  over  28 
years  ago,  and  ever  since  that  time  he  has  been  identified  with  the  den- 
tal supply  business.  The  Temple-Pattison  Company  deeply  feel  his  loss, 
as  must,  also,  his  numerous  friends. 


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SOCIETY  NOTES  67 

SOCIETY  NOTES 

District  of  Columbia. 

The  next  examination  of  applicants  for  license  to  practise  in  the  District  of  Columbia,  will 
be  held  at  the  George  Washington  University,  Washington,  January  3-6,  191 6.  Appli- 
cations should  be  in  the  hands  of  the  secretary  two  weeks  before  the  date  of  the  examina- 
tion.   Fee  $10— Stakr  Parsons,  1309  L  Street,  N.  W.,  Washington,  Secretary. 

Minnesota. 

The  thirty-third  annual  convention  of  the  Minnesota  State  Dental  Association  will  be 
held  at  the  University  of  Minnesota,  in  Minneapolis,  February  11-12,  1916. — Max 
E.  EiiNST,  614  Lowry  Bldg.,  St.  Paul,  Minn.,  Secretary. 

The  annual  meeting  of  the  American  Institute  of  Dental  Teachers  will  be  held  at 
Hotel  Radisson,  Minneapolis,  January  25,  26,  and  27,  1916. — ^J.  F.  Biddle,  Secretary, 

Missouri. 

The  next  meeting  of  the  Washington  University  Dental  Alumni  Association  will  be  held 
at  the  University  Dental  School,  February  21-22,  1916. — H.  M.  Fisher,  Metropolitan 
Bldg.,  St.  Louis,  Mo.,  Secretary. 

North  Carolina. 

The  next  meeting  of  the  North  Carolina  State  Board  of  Dental  Examiners  will  be  held 
at  Salisbury,  N.  C,  begiiming  promptly  at  9.00  o'clock  on  Thursday,  January  13,  191 6. 
For  further  information  and  application  blanks  address  the  Secretary,  F.  L.  Hunt,  Ashe- 
ville,  N.  C. 

North  Dakota 

The  next  meeting  of  the  North  Dakota  State  Board  of  Dental  Examiners  will  be  held 
at  Fargo,  N.  Dak.,  January  11,  1916.  For  further  information  address,  W.  E.  Hock- 
ing, Devil's  Lake,  N.  D. 

South  Dakota. 

The  South  Dakota  State  Board  of  Dental  Examiners  will  hold  its  next  meeting  at  Sioux 
Falls,  So.  Dak.,  January  11,  1916,  at  9  a.m.  sharp,  continuing  three  days.  All  appli- 
cations must  be  in  the  hands  of  the  Secretary  by  January  ist.  Fee  $25.  Aris  L. 
Revell,  Lead,  So.  Dak.,  Secretary. 

Wisconsin. 

The  next  meeting  of  the  Wisconsin  State  Dental  Society  will  be  held  in  Wausau,  Wis., 
July  11-13,  1916. — ^Theo.  L.  Gilbertson,  Secretary. 


FUTURE  EVENTS 


January  3-6,  19 16. — Board  of  Dental  Examiners  for  the  District  of  Columbia,  George  Wash- 
ington University,  Washington. — Starr  Parsons,  1309  L  Street,  N.  W.,  Secretary. 

January  11,  1916. — South  Dakota  State  Board  of  Dental  Examiners,  Sioux  Falls,  So.  Dak. — 
Aris  L.  Revell,  Lead,  S.  D.,  Secretary. 

January  10-13,  1916. — Montana  State  Board  Dental  Examiners. — G.  A.  Chevigney,  Secre- 
tary. 

January  11,  1916. — North  Dakota  State  Board  of  Dental  Examiners,  Fargo,  N.  Dakota. — 
W.  E.  Hocking,  Devils  Lake,  N.  D.,  Secretary. 


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68  THE  DENTAL  DIGEST 

January  13,  1916. — ^North  Carolina  State  Board  of  Dental  Examiners,  Salisbury,  N.  C. — 

F.  L.  Hunt,  Asheville,  N.  C,  Secreiary, 
January  25-27,  1916. — American  Institute  of  Dental  Teachers,  Minneapolis,  Minn. — ^J.  F. 

BiDDLE,  Secretary-Treasurer, 
January  28-29, 1916. — Annual  Clinic  of  the  Chicago  Dental  Society,  Hotel  La  Salle,  Chicago, 

lU. — Percy  B.  D.  Idler,  30  No.  Michigan  Ave.,  Secretary. 
February  11-12,  1916. — ^The  thirty-third  Annual  Meeting  of  the  Minnesota  State  Dental 

Association,  at  the  University  of  Minnesota,  Minneapolis. — Max  E.  Ernst,  614  Lowr>' 

Bldg.,  St.  Paul,  Minn.,  Secretary. 
February  16-18,  1916. — ^The  tenth  annual  clinic,  Manufacturers'  and  Dealers'  Exhibit  of  the 

Marquette  University  Dental  Alumni  Association,  Milwaukee  Auditorium,  Milwaukee, 

Wis. — V.  A.  Smith,  Secretary. 
February  21-22,  19 16. — Golden  Jubilee  of  the  Washington  University  Dental  School,  at  the 

Dental  School,  29th  and  Locust  Sts.,  St.,  Louis  Mo.— H.  M.  Fisher,  Metropolitan  Bldg., 

Secretary. 
February  23-24,  1916. — Central  Pennsylvania  Dental  Society,  Johnstown,  Pa. — Chairman 

Exhibit  Committee,  C.  A.  Matthews. 
March  20-26,  19 16. — ^The  Tri-State  Post  Graduate  Dental  Meeting  (Missouri,  Kansas,  Okla- 
homa), Kansas  City,  Mo. — C.  L.  Lawrence,  Enid,  Okla.,  Secretary. 
April  4-7,  1916. — Dental  Manufacturers'  Club,  Chicago,  111.       Meeting  in  the  Banquet 

Hall,  Auditorium  Hotel. — Chairman  Exhibit  Committee^   A.  C.  Clark,  Grand  Crossing, 

Chicago. 
April  14-16,  1916. — ^West  Vii^inia  State  Dental  Association,  Kanawha  Hotel,  Charleston. 
May,  1916. — Indiana  State  Dental  Association,  Claypool  Hotel,  Indianapolis,  Ind. — A.  R. 

Ross,  Secreiary. 
May  2-4,  1916. — Iowa  State  Dental  Society,  Des  Moines,  la.     H.  A.  Elmquist,  Des 

Moines,  la.,  Chairman  of  Exhibit. 
June,  191 6. — Florida  State  Dental  Society,  Orlando,  Fla. — M.  C.  Izlar,  Corres.  Secy. 
July  11-13,  19 16. — ^Wbconsin  State  Dental  Society  Meeting,  Wausau,  Wis. — ^Theo.  L.  Gil- 

bertson.  Secretary. 
October,  18-20,  1916. — Viiginia  State  Dental  Association,  Richmond,  Va. — C.  B.  Gifford, 

Norfolk,  Va.,  Corresponding  Secretary. 


IMPORTANT  POSTPONEMENT 

The  meeting  of  the  National  Association  of  Dental  Faculties  which  was  to  have  been  held 
in  Minneapolis,  January  28r-29,  1916,  has  been  postponed  to  meet  in  Louisville  in  July,  1916. 
The  exact  dates  will  be  announced  later. 

B.  Holly  Smith,  Chairman  Ex.  Com. 
N.  A.  D.  F. 


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The  Dental  Digest 

GEORGE  WOOD  GLAPP,  D.D.S.,  Editor 

Published  monthly  by  The  Dentists'  Supply  Company,  Candler  Bldg., 
Times  Square,  220  West  42d  Street,  New  York,  U.  S.  A.,  to  whom  all  com- 
munications relative  to  subscriptions,  advertising,  etc.,  should  be  addressed. 

Subscription  price,  including  postage,  $1.00  per  year  to  all  parts  of  the 
United  States,  Philippines,  Guam,  Cuba,  Porto  Rico,  Mexico  and  Hawaiian 
Islands.     To  Canada,  $1.40.     To  all  other  countries,  $1.75. 

Articles  intended  for  publication  and  correspondence  regarding  the  same 
should  be  addressed  Editor  Dental  Digest,  Candler  Bldg.,  Times  Square, 
220  West  42d  Street,  New  York,  N.  Y. 

The  editor  and  publishers  are  not  responsible  for  the  views  of  authors  ex- 
pressed in  these  pages. 

Entered  as  Second  Class  Matter,  at  the  Post-Office  at  New  York  City. 
Under  the  Act  of  Congress,  March  3,  1879. 


Vol.  XXI 1 


FEBRUARY,  1916 


No.  2 


TICLE3 


EXPERIMENTS  TO  DETERMINE  THE 
TOXICITY  OF  THERAPEUTIC  AGENTS 
IN  THE  TREATMENT  OF  PYORRHEA 
ON  ANIMAL  CELLS  GROWN  IN  VITRO 

By  W.  F.  Spies,  D.D.S.,  New  York 

In  the  therapeutic  treatment  of  all  infectious  conditions  and  of  in- 
flammations, the  objects  sought  are  threefold;  first,  to  reduce  the  power 
of  the  attacking  micro-organism,  at  least  to  the  point  of  harmlessness; 
second,  to  accomplish  the  object  with  the  minimum  of  irritation  or  dis- 
turbance of  local  tissue  cells;  third,  to  restore  normal  circulation  of  the 
blood  and  lymph. 

In  previous  investigations  to  determine  the  efficiency  of  any  particular 
preparation  or  method  of  treatment  of  such  conditions,  only  one  or  two 
of  the  objects  enumerated  have  usually  been  considered.  Estimations 
of  the  germicidal  efficiency  of  therapeutic  agents  have  been  frequently 
made  and  recommendations  for  use  have  been  based  upon  them,  without 
sufficient  thought  of  the  effect  of  such  agents  upon  the  tissue  cells. 

There  have  been  no  satisfactory  laboratory  methods  for  determining 
the  effects  of  germicides  and  antiseptics  upon  living  tissues,  and  of  re- 
cording the  effects  so  that  they  may  be  available  to  all.  It  is  apparent 
that  the  minute  tissue  effects  of  the  substances  employed  as  antiseptics 


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70  THE  DENTAL  DIGEST 

or  germicides  should  be  determined  by  exact  laboratory  methods  rather 
than  the  unorganized,  individual  observation  upon  which  we  have 
heretofore  depended. 

With  the  successful  growth  of  animal  tissue  cells  outside  of  the  body, 
there  came  opportunities  for  testing  the  germicidal  efficiency  and  tissue 
toxicity  of  various  therapeutic  agents  used  in  the  treatment  of  human  in- 
fections. Before  entering  into  a  detailed  consideration  of  the  experi- 
ments in  toxicity,  it  may  be  interesting  to  review  briefly  the  application 
of  the  principles  mentioned  in  the  first  paragraph  to  the  treatment  of 
pyorrhea. 

Pyorrhea  is  inflammation  of  the  tissues  surrounding  the  roots  of  the 
teeth.  In  treating  this  condition,  the  therapeutic  agents  which  have  the 
highest  germicidal  efficiency  with  minimum  toxic  or  tissue  destroying 
properties  should  be  selected.  It  is,  of  course,  most  desirable  to  destroy 
or  render  ineffective  the  pathogenic  or  pus-producing  bacteria  or  other 
micro-organisms  which  may  be  present  in  a  pyorrhea  pocket.  On  the 
other  hand,  it  is  important  that  the  indolent  cells  lining  a  pyorrhea  pKDckct 
shall  be  so  stimulated  that  they  will  promptly  resume  their  normal 
activities.  The  use  of  powerful  irritants  defeats  this  purpose  rather  than 
aids  it.  The  effect  of  such  agents  is  to  destroy  the  inflamed  cells  lining 
the  pocket,  to  increase  the  area  of  inflammation  and  to  retard  the  process 
of  repair. 

HISTORICAL 

The  later  researches  on  the  cultivation  of  tissue  cells  outside  the  body 
were  developments  from  the  original  studies  by  Roux  on  surviving  cells 
when  isolated  from  the  animal  organism.  It  was  here  that  the  need  for 
study  of  cell  activities  brought  about  efforts  toward  the  prolongation  of 
their  life.  A  similar  need  led  Harrison  to  further  develop  the  method  to 
the  end  that  proofs  of  the  origin  of  nerve  fibres  might  be  obtained.  Com- 
plete isolation  of  the  growing  nerve  from  other  tissue  cells  was  a  pre- 
requisite. 

The  necessity  for  supplying  nutrient  material  to  the  cells  during 
growth  brought  about  the  utilization  of  various  forms  of  lymph  and 
blood  plasma  in  the  artificial  cell  cultures.  It  might  be  said  that  the 
present  methods  are  largely  based  upon  the  work  done  by  Dr.  M.  T.  Bur- 
rows, in  the  Sheffield  Biological  Laboratory  in  Yale,  1910.  In  later  re- 
searches, fresh,  unclotted  blood  plasma  served  as  a  nutrient  fluid  for  the 
cell  cultures. 

With  the  greater  improvement  in  details  of  the  technique  made  by 
Carrel  and  Burrows,  there  came  the  final  procedure,  which  has  had  a  wide 
application  in  attempts  to  solve  a  variety  of  problems.  Thus,  the  meth- 
ods of  tissue  cell  cultures  have  been  easily  adapted  to  the  study  of  an- 


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TOXICITY  OF  THERAPEUTIC  AGENTS  IN  PYORRHEA  71 

atomical,  pathological  and  physiological  problems.  Carrel  has  applied 
it  to  the  solution  of  problems  in  surgery  and  for  estimating  the  various 
methods  of  preserving  tissues.  Lambert  and  Hanes  have  used  it  for  the 
study  of  cytotoxins,  while  Murphy  has  made  excellent  use  of  the  process 
in  efforts  to  solve  problems  in  immunity  in  tumor  growth. 

It  remained  for  those  who  have  undertaken  the  investigations  about 
to  be  reported,  to  apply  this  procedure  to  the  problems  of  determining 
the  relative  toxicity  of  germicidal  and  antiseptic  agents  upon  tissue  cell 
cultures.  Prior  to  these  studies,  the  only  available  laboratory  procedures 
for  the  determination  of.  toxicity  of  such  products  consisted  in  the  sub- 
cutaneous injections  of  dilutions  of  them  into  animals,  particularly  white 
mice,  the  end  reaction  being  the  death  or  survival  of  the  animal.  This 
latter  procedure  constituted  a  more  or  less  satisfactory  process  for  deter- 
mining the  massive  toxic  doses  of  the  agent  or  preparation  in  question. 
The  results,  however,  constituted  no  satisfactory  indication  of  the  actual 
toxicity  of  any  degree  of  dilution.  Nor  could  the  effects  upon  in- 
dividual cells  or  small  groups  of  cells  be  measured.  It  is  obvious  that  the 
results  of  tests  with  massive  doses  would  be  entirely  inappropriate  for  the 
determination  of  the  finer  degrees  of  toxic  action  against  small  groups  of 
tissue  cells,  such  as  would  be  affected  in  the  application  of  any  therapeutic 
agent  in  the  treatment  of  pyorrhea. 

In  the  development  of  the  method  of  testing  tissue  cell  toxicity  by  the 
use  of  cell  cultures,  much  time  was  spent  in  preliminary  investigations. 
From  these  investigations,  a  procedure  which  gave  reasonably  satisfactory 
results  was  finally  determined.  The  following  is  a  description  of  the 
technique  of  that  method. 

TECHNIQUE 

The  medium  for  growing  the  tissue  was  obtained  in  the  following  way. 
The  blood  was  collected  from  the  jugular  vein  of  a  chicken  by  means  of  a 
sterilized  cannula  which  had  been  previously  immersed  in  olive  oil.  The 
blood  was  allowed  to  flow  into  a  sterile  thin  glass  test  tube.  Small  pieces 
of  ice  were  put  around  the  base  of  the  test  tube  on  the  dissecting  table,  so 
as  to  chill  the  blood  immediately  and  prevent  coagulation.  When  about 
half  full,  the  tube  was  put  in  a  dish  of  ice.  About  eight  test  tubes  of 
blood  were  collected  each  time.  As  soon  as  possible  these  test  tubes  were 
packed  in  ice  in  a  centrifuge  tube  and  centrifuged  for  five  minutes  at  2,700 
revolutions  per  minute.  The  clear  plasma  was  then  drawn  off  with  a 
pipette  and  put  in  another  small  sterile  test  tube  and  the  tube  corked. 
These  corked  tubes  were  kept  on  ice  until  ready  for  use.  Plasma  kept 
in  this  way  was  found  to  produce  good  growth  even  when  it  was  a  month 
old. 


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72  TH£  DBNTAL  DIGEST 

In  these  tests,  two  parts  of  plasma  were  diluted  with  one  part  of 
Ringer's  solution*  and  a  drop  of  this  medium  was  put  on  a  cover  slip  with 
a  piece  of  tissue  and  coagulation  took  place  in  a  very  short  time.  A  hol- 
low ground  slide  ringed  with  vaseline  was  then  inverted  over  the  cover 
slip.  The  cover  slip  was  sealed  to  the  slide  with  hot  paraffin.  The  slides 
were  kept  in  an  incubator  at  39°  C. 

The  tissue  for  these  tests  was  obtained  from  chick  embryos  10-15 
days  old.  The  tissue  was  cut  up  into  very  small  pieces  under  a  magnify- 
ing lense.  Sterile  black  paraffin  in  Petri  dishes  was  found  to  give  a  better 
cutting  surface  than  glass. 

Portions  of  this  finely  divided  tissue  were  transferred  on  the  blade  of 
the  scalpel  to  sterile  watch  glasses  containing  i  cc.  of  sterile  Ringer's 
solution.  These  watch  glasses  were  contained  in  sterile  Petri  dishes  as  a 
protection. 

The  substances  to  be  tested  were  tincture  of  iodine  (U.  S.  Ph.)  and 
dentinol.  These  were  diluted  with  Ringer's  solution  in  the  proportion 
of  I  of  dentinol  or  iodine  to  49  of  Ringer's  solution  written  as  follows: 
I — 50,  and  in  i — 100,  i — 200,  i — 400.  The  addition  of  i  cc.  of  the  dilu- 
tion to  I  cc.  of  Ringer's  solution  containing  the  tissue  gave  the  required 
dilutions.  The  tissue  obtained  from  the  chick  embryos  was  exposed  to 
the  test  substance  for  five  minutes.  It  was  then  transferred  by  means  of 
a  pipette  to  another  Petri  dish  containing  15  cc.  of  Ringer's  solution  to 
wash  the  tissue.  These  Petri  dishes  were  then  placed  in  the  incubator 
until  ready  for  planting.  All  these  operations  were  done  in  a  warm  room 
and  the  solutions  coming  in  contact  with  the  tissue  were  warmed  to 
prevent  chilling  it.  Also  all  preparations  for  the  test  were  made  before- 
hand, so  as  to  have  the  time  elapsing  between  the  cutting  up  of  the  tissue 
and  the  planting  and  placing  in  the  incubator  as  short  as  possible. 

RESULTS  OF  A  REPRESENTATIVE  TEST 

The  material  tested  and  the  results  of  a  representative  test  are  given 
in  the  table  below  and  show  the  growth  or  non-growth  of  the  tissue  in  the 
different  dilutions  on  five  minutes'  exposure. 

—  No  growth 
-h  Growth 
Dentinol  5  Minutes*  Exposure 

Specimen 
No.  I     Xo.  2    No.  3 

1-50 +  +  + 

I— 100 +  +  + 

1—200 -h  -\-  -f 

1—400 -f  -I-  -f- 

*Ringer's  Solution  is  Sodium  Chloride  0.7%,  Calcium  Chloride  0.025%,  Potassium  Chlor- 
ide 0.03%,  Distilled  Water 


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TO  PREVENT  MODEL  FROM  BREAKING  73 

TmcTURE  OF  Iodine  (U.  S.  Ph.)  5  Minutes'  Exposure 

Specimen 
No.  I    No.  2    No.  3 

1—50 +  "~  ~ 

I — 100 —  +  — 

I — 200 +  +  — 

1—400 -f  +  + 

CONTROL 

Tissue  not  treated +         -f  + 

The  results  indicate  that  under  these  conditions,  a  dilution  of  den- 
tinol  I  in  50,  is  as  free  from  toxic  action  as  a  dilution  of  iodine  i  in  400. 

SUMMARY 

A  study  of  the  literature  on  tissue  cultivation  and  the  results  of  the 
foregoing  tests  bring  out  several  very  important  points: 

1.  The  primary  object  in  growing  tissue  outside  of  the  animal  body 
is  that  it  may  be  microscopically  observed  in  the  living  condition. 

2.  Interesting  observations  on  cell  division  and  many  other  problems 
are  better  studied  by  using  the  method  of  tissue  cultivation. 

3.  The  culture  methods  offer  a  promising  means  for  the  study  of  the 
response  of  cells  to  directive  stimuli. 

4.  That  wound  healing  could  be  imitated  in  culture. 

5.  A  satisfactory  method  has  been  developed  for  the  comparative 
estimation  of  the  toxic  effects  of  antiseptic  and  germicidal  agents  upon 
tissue  cells  by  the  use  of  the  cell  culture  method. 

6.  In  the  treatment  of  pyorrhea  the  therapeutic  agents  which  have 
the  highest  germicidal  efficiency  with  minimum  toxic  or  tissue  destroying 
prof)erties  should  be  selected. 

BIBLIOGRAPHY 

1.  Roux — Virchow's  Archiv.  Bd.  114 — 1888. 

2.  Harrison — ^Trans.  Cong,  of  Am.  P.  &  S.,  Vol.  IX,  1913. 

3.  Burrows — ^Trans.  Cong,  of  Am.  P.  &  S.,  Vol.  IX,  1913. 

4.  Carrel  and  Burrows — ^Joum.  Exp.  Med.,  191 1 — xiii. 

5.  Carrel  and  Burrows — Joum.  Exp.  Med.,  1911 — xiv. 

6.  Carrel— Joum.  Exp.  Med.— Vol.  XVIII— 1913. 

7.  Burrows — ^Joum.  Am.  Med.  Ass*n.,  1910 — Iv. 

8.  Carrel — ^Joum.  Am.  Med.  Ass'n.,  191 2 — lix. 

9.  Lambert  and  Hanes — Joum.  Exp.  Med.,  1911 — xiv. 
10.  Murphy — ^Journ.  Am.  Med.  Ass*n.,  19 13 — xvii. 


TO  PREVENT  MODEL  FROM  BREAKING 

Most  plate  makers,  occasionally  break  model  of  lower  case,  at 
angle,  in  separating  flask  preparatory  to  removing  wax.  This  will  be 
avoided  by  prying  flask  apart  in  front  (at  toe)  instead  of  in  the  back 
(or  heel).    The  action  is  like  a  hinge  and  naturally  unhooks  model. 

Will  S.  Kelly,  D.D.S.,  Wilkes-Barre,  Pa. 


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74  TH£  DENTAL  DIGEST 

CLOSED  MOUTH  IMPRESSIONS* 

By  Samuel  G.  Supplee,  New  York,  N.  Y. 
second  paper 

diagnosis  of  the  conditions  in  the  mouth 

It  is  very  important  to  diagnose  conditions  in  the  mouth  very  care- 
fully before  starting  to  take  your  impression,  for  facts  gained  in  this 
examination  will  be  of  great  value  to  you  in  fitting  your  tray,  taking  the 
bite  and  finishing  the  plate  as  well  as  allowing  for  the  settling  of  the 
denture. 

In  view  of  the  fact  that  it  is  desirable  to  retain  the  upper  denture 
principally  by  means  of  adhesion  by  contact,  it  naturally  follows  that  the 
larger  the  area  covered  by  the  plate,  the  greater  will  be  the  retentive 
power.  The  smaller  the  mouth,  the  more  difficult  it  is  to  secure  the 
desired  retention. 

THE    AREA    OF    THE   PLATE 

In  examining  the  mouth  it  is  important  that  we  shall  plan  to  make 
the  plate  cover  as  much  area  as  the  existing  conditions  will  permit. 
This  applies  particularly  to  the  length  of  the  plate,  antero-posterially. 
When  the  ridge  is  hard  in  front,  the  plate  can  extend  to  the  edge  of  the 
vibrating  portion  of  the  soft  palate. 

When  the  ridge  is  soft  in  front,  it  must  extend  beyond  the  hard  palate 
far  enough  so  that  the  edge  of  the  plate  may  press  upon  the  soft  palate 
and  embed  itself  sufficiently  to  compensate  for  the  amount  the  soft  ridge 
will  give  when  pressure  is  brought  to  bear  on  the  front  teeth. 

By  the  old  method  of  plate  work,  we  should  be  limited  in  extending  a 
plate  back  as  far  as  desirable  owing  to  nausea,  but  by  observing  the 
principles  outlined  this  difficulty  is  eliminated. 

POINTS   FOR  DIAGNOSIS 

Every  mouth  should  be  examined  in  the  following  respects: 
The  character  and  extent  of  soft  and  hard  tissues  overlying  the  hard 
palate.  Several  pounds'  pressure  should  be  exerted  with  the  tip  of  the 
finger  to  disclose  any  hard  bone  hidden  under  the  mucous  membrane, 
that  proper  relief  can  be  placed  on  the  model  to  allow  for  the  settling  of 
the  denture.  It  is  surprising  how  many  hundred  plates  are  failures  due 
to  lack  of  the  proper  relief  in  the  median  line  which  Dr.  Haskell  called 
particular  attention  to  many  years  ago. 


*This  article  began  in  the  January  191 6  issue. 


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CLOSED  MOUTH  IMPRESSIONS 


75 


Where  the  vibrating  portion  of  the  soft  palate  begins. 

The  character  and  extent  of  soft  tissue  if  in  the  region  of  the  ridges. 

The  location  and  strength  of  the  muscular  attachments  on  the  buccal 
and  labial  border  of  the  upper  ridge  and  both  sides  of  the  lower  ridge. 

The  space  between  the  tuberosities  of  the  upper  ridge  and  the  coronoid 
process  and  rami  when  the  mouth  is  opened  and  closed. 

METHODS    OF   DIAGNOSIS 

Examinations  should  be  made  with  the  index  finger  with  the  mouth 
open  and  closed. 

All  unusual  conditions  should  be  recorded  on  a  chart.  They  will  aid 
in  making  the  dentures  or  in  satisfying  the  patient. 

The  chart  used  at  the  Gysi  school  of  articulation  is  reproduced  on 
this  page.     It  foUows  very  closely  Dr.  McLeran's  design. 


Chart  for  Arti6cial  Dentures  (After  that  compiled  by  Dr.  McLeran,  Omaha,  Neb.) 

In  making  this  diagnosis  it  is  advisable  never  to  look  into  the  mouth 
until  you  have  made  a  careful  examination  with  the  index  finger  wh^e 
having  the  patient  open  and  close  a  number  of  times.  By  using  the 
point  of  the  finger  as  a  measuring  instrument,  you  are  able  to  get  a  very 
complete  idea  of  the  possible  height  of  the  rim  of  the  proposed  plate. 

By  using  heavy  pressure  with  the  index  finger,  you  can  determine  the 
depth  and  area  of  the  movable  tissue  overlying  the  rear  half  of  the  hard 
palate,  and  the  conditions  of  the  ridge  in  the  region  of  the  eight  front 


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76  THE  DENTAL  DIGEST 

teeth.    This  should  guide  you  as  to  the  length  of  the  plate  antero- 
posterially. 

The  knowledge  of  these  conditions  will  be  of  great  value  to  you  in 
case  you  should  have  trouble  in  securing  the  desired  results. 

HIGH   AND   LOW   RIMS 

The  height  of  the  rim  will  be  determined  by  the  range  of  movements  of 
the  attachments  when  the  mouth  is  open  and  closed.  If  the  action  is 
short  and  strong,  your  rim  should  be  low.  If  long  and  weak,  your  rim 
should  be  high. 

VULCANITE   AND   METAL  PLATES 

If  the  entire  vault  and  ridges  are  extremely  hard  and  flat  and  the 
muscles  attached  close  to  the  crest  of  the  ridge,  it  is  advisable  to  make  a 
rubber  plate  for  the  patient  to  wear  at  least  a  year  or  so  until  the  action 
of  rubber  causes  the  tissues  to  become  softer,  at  which  time  a  metal  plate 
can  be  made  with  better  results. 

If  the  mouth  has  a  tendency  to  soft  ridges  and  an  excess  amount  of 
soft  tissue  in  the  vault,  it  is  wise  to  advise  the  patient  to  have  a  metal 
plate. 

A  temporary  gold  lined  plate  should  be  made  for  the  patient  to  wear 
for  a  year  to  partially  reduce  the  inflammation  before  making  the  metal 
plate. 

If  the  patient  is  limited  in  means,  very  good  results  can  be  secured  by 
refitting  the  old  rubber  plate  and  lining  it  with  foil  gold  as  a  temporary 
plate  for  six  months,  to  reduce  the  inflammation  before  making  a  gold  or 
metal  plate. 

If  the  old  rubber  plate  fits  fairly  well,  place  a  gold  lining  in  it  without 
changing,  as  the  shrinkage  of  the  rubber  plus  the  thickness  of  the  lining 
will  improve  the  fit  sufficiently  to  last  till  the  inflammation  from  the 
rubber  is  materially  reduced  before  making  a  metal  plate. 

It  is  very  unfortunate  that  so  few  dentists  spend  the  necessary  time 
to  induce  the  patients  to  have  metal  plates. 

From  general  observation  the  one  great  reason  for  this  has  been  that 
they  could  not  be  so  sure  of  securing  a  well-fi.tting  denture. 

There  are  three  principal  causes  for  this  existing  condition: 

First,  so  little  attention  has  been  given  to  essentials  of  an  impression 
that  comparatively  few  plates  would  be  a  success  were  it  not  for  the  fact 
that  the  inflammation  created  by  the  rubber  in  contact  with  the  tissue 
will  compensate  for  the  deficiencies. 

Second,  most  metal  plates  are  made  for  patients  after  they  have  been 
wearing  either  a  temporary  rubber  plate,  or  because  the  mouth  has  been 
inflamed  by  wearing  a  rubber  plate  too  long. 


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CLOSED  MOUTH  IMPRESSIONS  77 

If  a  well  fitting  gold  plate  is  placed  in  a  mouth  of  this  kind,  it  is  only 
a  short  time  when  the  inflammation  is  materially  reduced  and  the  plate 
does  not  fit. 

As  the  gold  plates  have  been  made  from  the  same  imperfect  impres- 
sions as  rubber,  and  the  fit  was  no  better  to  start  with,  they  certainly 
have  a  decided  disadvantage  as  they  have  a  tendency  to  reduce  inflamma- 
tion rather  than  to  cause  it. 

Third,  most  gold  plates  have  been  swaged  of  metal  heavier  than  28 
gauge  and  it  is  very  difiicult  to  make  this  material  conform  to  the  minute 
details  of  the  model. 

There  are  many  ways  in  which  these  difficulties  can  be  overcome,  and 
they  will  be  outlined  more  fully  in  a,  chapter  on  metal  plates. 

There  are  recent  improvements  by  which  we  can  cast  and  condense 
an  aluminum  plate  from  an  artificial  stone  model  and  then  eliminate  the 
contraction  by  using  a  putty  or  shot  swage  to  drive  it  to  an  accurate  fit 
and  incidentally  further  condense  the  metal. 

The  triple  refined  aluminum  which  can  now  be  secured  has  prac- 
tically eliminated  all  the  former  troubles  of  distintegration. 

In  this  way  we  are  able  to  eliminate  many  of  the  difficulties  due  to 
the  expansion  and  shrinkage  of  rubber  and  make  a  cheap  durable  plate 
which  on  the  whole  is  far  superior  to  rubber. 

HISTORY    OF   THE    CASE 

It  is  well  to  go  into  the  history  of  the  case  in  hand  before  promising 
the  patient  quick  and  positive  results,  for  the  question  of  muscle  strain 
and  muscular  development  will  play  a  prominent  part  in  view  of  the 
fact  that  we  are  going  to  use  the  muscles  indirectly  to  hold  our  plates  in 
their  proper  position. 

GRADUAL   DEVELOPMENTS 

If  the  patient  has  been  masticating  for  a  number  of  years  on  a  few 
miscellaneous  teeth  with  the  jaw  abnormally  closed,  or  masticating  on 
one  side  only,  or  gone  without  teeth  entirely,  we  cannot  expect  to  open 
the  bite  and  place  the  jaws  in  their  correct  position  and  expect  them 
to  be  fully  efficient  and  remain  in  the  same  corelation  after  the  muscles 
have  been  fully  developed  in  their  new  position. 

This  development  should  be  accomplished  in  stages  if  we  are  to 
expect  to  pve  our  patient  the  comfortable  use  of  the  plates  during  the 
development  period.  I  shall  attempt  to  deal  with  this  subject  in  the 
chapter  on  ** Muscle  and  Tissue  Development." 

The  ignorance  of  this  subject  has  been  the  cause  of  considerable  loss 
in  the  average  dental  practice,  as  many  dentists  have  made  two  or  more 
sets  of  plates  for  patients,  carrying  them  through  this  development  stage 


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78  THE  DEHTAL  DIGEST 

without  knowing  it,  before  securing  permanent  results,  yet  have  received 
only  one  fee  and  have  wound  up  with  a  dissatisfied  patient,  complaining 
because  the  plates  were  not  made  right  the  first  time. 

If  conditions  had  been  properly  understood,  arrangements  could  have 
been  made  for  the  patient  to  have  comfort  during  the  development  stage, 
and  pay  for  the  dentures  necessary  to  accomplish  the  desired  results. 
This  article  is  expected  to  be  continued. 


SHORTAGE  OF  DENTAL  PRACTITIONERS 

The  institution  of  a  diploma  in  dental  surgery  took  place  compara- 
tively recently  in  this  country.  The  result  is  that  the  number  of  qualified 
dentists  is  far  short  of  the  requirements  of  the  population,  and  that  a  large 
number  of  unqualified  men  practice.  They  are  not  prevented  from  doing 
this,  but  they  must  not  call  themselves  dentists.  This  is  a  very  small 
drawback,  as  they  can  exhibit  sets  of  teeth  and  call  themselves  "tooth 
specialists."  At  a  meeting  of  the  General  Medical  Council,  Mr.  Tomes, 
chairman  of  the  Dental  Education  and  Examination  Committee,  sub- 
mitted a  report  on  the  shortage  of  dentists.  Communications  had  been 
made  with  the  various  licensing  bodies  for  the  possibility  or  curtailment 
of  the  curriculum  without  lowering  the  standard  of  dental  practice. 
Some  of  the  bodies  questioned  the  existence  of  any  shortage,  pointing  out 
that  many  qualified  men  are  not  fully  occupied,  the  public  being  uncon- 
vinced of  their  advantage  over  the  unqualified.  Attention  was  also 
drawn  to  the  lowering  of  the  social  status  which  arose  from  the  intrusion 
of  great  numbers  of  unqualified  persons,  and  to  the  fact  that  business 
men  who  had  acquainted  themselves  with  the  existing  state  of  things 
often  considered  that  from  a  business  point  of  view  qualification  was 
worthless  or  even  a  hindrance,  and  so  did  not  put  their  sons  at  dental 
schools.  The  Incorporated  Dental  Hospital  of  Ireland  alone  considered 
the  possibility  that  the  simpler  dental  requirements  sought  by  the  poorer 
classes  might  perhaps  be  met  by  a  lower  grade  of  practitioner,  though 
this  was  also  suggested  in  one  of  several  letters  sent  by  private  prac- 
titioners. The  main  conclusion  was  that  no  appreciable  increase  in  the 
members  of  the  dental  profession  can  be  looked  for  until  the  law  gives 
further  protection  to  the  qualified  man  against  the  unqualified.  A  very 
insidious  form  of  deception  was  pointed  out.  An  unqualified  man  dare 
not  put  on  his  plate  "dental  surgeon,"  as  this  would  render  him  liable  to 
prosecution.  This  is  avoided  by  putting  beneath  his  name  "dental 
surgery,"  which  can  be  done  with  impunity.— /t^ttrwa/  American 
Medical  Association, 


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WESTERN  ATTITUDE  TO  ANATOMICAL  ARTICULATION  70 

A  TRIP  REGISTERING   THE  WESTERN  ATTITUDE  TO 
ANATOMICAL  ARTICULATION 

By  Dayton  Dunbar  Cabipbell,  D.D.S.,  Kansas  City,  Mo. 

While  in  Kansas  City  conducting  a  class  in  Conductive  Anesthesia, 
Dr.  Arthur  E.  Smith  of  Cleveland  suggested  the  trip.  Having  learned 
that  I  was  to  be  one  of  the  essayists  of  the  Montana  State  Dental  Asso- 
ciation in  July  and  that  I  planned  to  be  at  the  Panama-Pacific  Dental 
Congress  in  September,  he  said,  "why  not  teach  the  Gysi  method  of 
Anatomical  Articulation  during  the  interval?" 

Acting  upon  this  suggestion,  a  small,  strong,  trunk  was  packed  with 
dental  materials,  and  appurtenances  not  readily  found  in  every  city, 
Gysi  Adaptable  Articulator,  a  steropticon,  Spencers  Plaster  Compound, 
SoreFs  Cement,  pure  aluminum  ingots,  nearly  two  hundred  and  fifty 
lantern  slides,  etc. 

At  the  meeting  in  Helena  I  constructed  a  full  upper  and  lower  set 
of  dentures  upon  vulcanite  bases  for  one  of  the  oldest  members  of  the 
Montana  State  Association.  The  Gysi  Adaptable  Articulator  and 
Trubyte  teeth  were  used.  Trubyte  teeth  were  employed  in  every  case 
throughout  the  trip. 

The  following  Monday  found  me  in  Spokane,  Wash.,  where  I  brought 
to  Mr.  R.  A.  Monro's  attention  some  of  the  results  of  my  efforts  in 
Anatomical  Articulation  (I  carried  exhibits  on  four  Simplex  Articulators). 

Dr.  Munro's  interest  secured  an  audience  of  about  fifty  dentists  that 
Monday  evening.  The  lantern  lecture,  the  clinical  material,  and  a  free 
and  informal  discussion,  made  possible  a  very  pleasant  evening.  At  the 
close  of  the  session,  an  opportunity  was  afforded  those  interested  to 
join  a  class  in  Anatomical  Articulation. 

On  account  of  such  brief  notice,  many  who  expressed  a  desire  to  join 
these  classes,  were  unable  to  arrange  their  professional  engagements,  so 
as  to  avail  themselves  of  the  opportunity. 

It  might  be  well  to  interpolate  here  that  the  writer  was  not  idle  while 
the  classes  were  not  in  session.  The  most  enjoyable  part  of  my  trip 
was  spent  in  the  various  oflSces  of  these  men  assisting  with  difficult  cases. 
Dr.  R.  I.  Vandewall,  of  Seattle  and  Dr.  Leland  D.  Jones  of  San  Diego 
each  had  a  case  in  which  the  patient  presented  a  mouth  with  soft  flabby 
ridges  in  the  region  extending  from  I'.uspid  to  bicuspid.  This  tissue 
was  injected  with  a  local  anesthetic  and  \  :*.th  a  pair  of  heavy  gum  scissors, 
cut  away  bodily.  Such  treatment  leaves  the  part,  after  a  period  of  two 
of  two  or  three  weeks,  in  a  condition  to  receive  a  denture  that  will  be 
permanent  and  eminently  satisfactory. 


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80  THE  DENTAL  DIGEST 

Dr.  Francis  R.  Fisk  secured  a  large,  well  lighted  room  in  the  Old 
National  Bank  Building  where  we  met  every  afternoon  for  four  days. 
Two  full  upper  and  lower  sets  of  dentures  were  made  for  different  pa- 
tients, one  upon  the  Gysi  Adaptable  Articulator  and  the  other  upon  the 
Gysi  Simplex  using  the  face  bow,  by  the  double  vulcanization  process; 
the  other,  a  cast  aluminum  base  for  the  upper  and  lower  vulcanite.  The 
evening  of  July  26th  was  spent  before  a  called  meeting  of  the  Seattle 
Dental  Society.  Here  we  had  the  pleasure  of  renewing  our  acquaintance 
with  Dr.  C.  J.  Stansbery  and  that  of  meeting  Dr.  Frank  W.  Hergert 
who  were  members  of  the  second  Gysi  class  in  Anatomical  Articulation. 
Dr.  Leo  M.  Trowbridge  an  upper  classman  of  my  college  days  gave  us  a 
splendid  impression  of  the  city  and  its  boulevards  and  contributed  largely 
to  the  enjoyment  of  our  stay.  Through  the  kindly  assistance  volun- 
teered by  Dr.  Hergert  and  Dr.  Stansbery,  the  Seattle  class  was  organized 
without  any  particular  effort  on  my  part.  The  writer  felt  not  a  little 
complimented  with  the  regular  attendance  of  these  two  men,  who  were  as 
familiar  with  the  Gysi  methods  as  the  writer  himself. 

Although  I  have  traveled  somewhat  extensively  during  my  short 
career  as  a  dentist,  I  have  never  visited  in  any  other  city  where  there 
were  so  many  well  lighted  and  cleanly  kept  offices,  neatly  gowned 
assistants,  and  broad,  open  minded  dentists,  as  I  found  in  Seattle. 

The  course  in  Seattle  was  started  with  a  lecture  on  the  26th  but  was 
not  completed  until  the  following  week. 

In  the  meantime  I  visited  Vancouver,  British  Columbia,  to  lecture 
before  the  Vancouver  Dental  Society  on  Tuesday  evening.  Here  one 
of  my  Gysi  classmates,  Dr.  W.  H.  Thompson,  rendered  indispensable 
assistance  in  organizing  the  class.  Here  could  be  seen  at  any  time,  sol- 
diers in  uniform  getting  ready  to  ship  for  the  war.  Great  difficulty  was 
experienced  in  passing  my  lantern  slides  through  the  customs.  Prac- 
tically no  attention  was  given  to  the  rest  of  my  paraphernalia. 

Through  the  courtesy  of  Mr.  J.  W.  Henderson,  manager  of  The 
Temple-Pattison  Co.,  a  room  adjoining  their  dental  depot  was  secured. 
It  was  from  Mr.  Basil  Bayne  of  the  Bayne  Bros.  Dental  Laboratory  that 
we  learned  to  xnilcanize  gold-dust  rubber  in  the  spoon  end  of  a  wax 
spatula  by  heating  slowly  and  until  it  became  fluid.  By  this  method  a 
tooth  may  be  attached  to  a  plate  in  five  minutes  where  otherwise  it 
would  take  an  hour  and  a  half.  Other  rubbers  cannojt  be  used  since  they 
contain  no  aluminum;  the  heat  conducting  element  is  essential. 

Some  of  the  dentists  in  this  class  were  so  enthusiastic  with  this  work 
that  they  wrote  to  their  confreres,  in  Victoria  suggesting  that  they 
organize  a  similar  class.  In  the  meantime  I  returned  to  Seattle  and 
proceeded  with  the  work  there. 


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WESTERN  ATTITUDE  TO  ANATOMICAL  ARTICULATION  81 

There  were  thirteen  bonafide  members  to  the  Victoria  class  including 
Dr.  Knight  who  does  not  appear  in  the  picture,  together  with  each  man's 
student  assistant.  These  students  acting  as  apprentices  are  thereby 
fulfilling  some  of  the  dental  requirements  of  the  Dominion.  This  class 
was  held  in  the  Garesche  Building  adjacent  to  the  offices  of  Dr.  A.  J. 
Garesche  whose  services  and  courtesies  were  much  appreciated.  Dr. 
H.  LeRoy  Burgess  was  a  former  classmate  of  mine  in  the  Kansas  City 
Dental  College.  Our  hair-raising  drive  over  Mt.  Malahat  in  his  power- 
ful McLaughlin  on  high  speed,  and  our  little  dinner  at  the  beach  with 
the  other  members  of  the  class,  will  not  soon  be  forgotten. 


The  classes  in  Portland,  San  Diego,  Salt  Lake  City,  and  Denver 
were  held  from  four  to  six  in  the  afternoon  and  from  seven  to  ten  in  the 
evening.  We  regret  that  these  hours  together  with  the  rush  of  work, 
necessarily  eliminated  the  photographer. 

Those  in  the  Portland  class  were  Dr.  Treve  Jones,  Dr.  W.  C.  Adams, 
Dr.  Chapin  F.  Laudervale,  Benj.  E.  Gulick,  and  Dr.  Clyde  Mount  of 
Oregon  City.  It  was  here  that  I  had  the  pleasure  of  discussing  Dr.  J. 
Leon  Williams'  book  on  "A  New  Classification  of  Artificial  Teeth." 

While  the  Panama-Pacific  Congress  was  not  as  large  as  some  other 
dental  meetings  previously  attended,  every  clinic  and  every  lecture  was 
well  attended  and  several  of  these  were,  by  request,  repeated.  This 
was  particularly  true  of  Dr.  C.  J.  R.  Engstrom's  motion  pictures  showing 


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82 


TH£  DENTAL  DIGEST 


the  use  of  the  Gysi  Adaptable  Articulator.  Here  we  had  the 
pleasure  of  serving  as  a  clinician  in  Dr.  Frank  W.  Hergert's  section,  on 
**The  Gysi  Methods  of  Anatomical  Articulation." 

The  men  specially  interested  in  Prosthetic  procedure  quite  naturally 
became  well  acquainted  with  each  other  in  discussing  the  relative  merits 
of  the  Greene  Method  of  Impression  taking  and  the  new  Hall  method  of 
perfected  plaster  impressions.     Dr.  Rupert  E.  Hall  of  Houston,  Texas, 


Front  Row,  left  to  right:  Dr.  F.  J.  Lenz;  Dr.  G.  J.  Whitfield;  Patient;  Dr.  C.  J.  Stans- 
bery;  Dr.  D.  D.  Campbell;  Dr.  F.  W.  Hergert;  Miss  Moore;  Dr.  C.  H.  Wharton 

Back  Row,  left  to  right:  Dr.  D.  W.  Bennett;  Dr.  N.  H.  Smith;  Dr.  W.  S.  Padget;  Dr. 
L.  M.  Trowbridge;  Dr.  W.  L.  Harrison;  Dr.  R.  I.  Vandewall;  Dr.  E  S.  Sweeney;  Dr.  C.R. 
Oman;  Dr.  H.  W.  Appleby;  Dr.  L.  E.  A.  Hooey;  Dr.  E.  B.  Edgers;  Dr.  B.  S.  McCord 

maintained  that  no  material  which  offers  resistance  to  the  tissues  was 
suitable  for  taking  impressions,  and  claimed  that  the  apparent  success  of 
the  Greene  method,  was  due  to  the  fact  that  its  use  produced  a  vacuum 
over  the  entire  maxillary  surface  or  intaglio  of  the  impression  save  on  the 
periphery  or  the  well  massaged  borders  and  post-dammed  palate.  This 
small  vacuum  over  the  entire  surface  of  the  impression,  constitutes  an 
element  of  unconscious  deception,  deceiving  not  only  the  patient  but 
also  the  dentist  himself.  The  vast  majority  of  those  questioned  by  the 
writer,  admitted  that  they  had  never  constructed  a  denture  that  fitted  so 


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WESTERN  ATTITUDE  TO  ANATOMICAL  ARTICULATION 


83 


tightly  and  snugly  after  a  few  days'  time  as  the  tested  compound  im- 
pression. 

I  should  like  to  mention  here  one  lesson  that  I  have  learned  thoroughly, 
viz. ;  that  no  patient  should  be  given  a  demonstration  tending  to  show 
how  very  satisfactorily  his  completed  denture  will  be  retained — rather, 
that  more  stress  should  be  laid  upon  the  personal  equation  represented  in 
the  patient.    The  patient  should  learn  that  successful  dentures  are  pro- 


Front  Row,  left  to  right:  Dr.  G.  Dier;  Dr.  W.  F.  Fraser;  Dr.  A.  J.  Garesche;  Dr.  D.  D. 
Campbell;  Dr.  Lewis  Hall;  Dr.  A.  H.  Tanner 

Back  Row,  left  to  right:  Dr.  S.  G.  Clemence;  Mr.  J.  Crossan;  Dr.  H.  H.  Hare;  Dr.  H. 
LeRoy  Burgess;  Dr.  E.  H.  Griffith;  Dr.  Alf.  J.  Thomas;  Dr.  H.  J.  Henderson 

duced  through  two  equal  factors;  constructive  on  the  part  of  the  operator 
and  adaptive  on  the  part  of  the  one  operated  on. 

The  San  Diego  class  composed  of  Drs.  H.  C.  Collins,  Leland  D.  Jones, 
Chas.  G.  Giddings,  W.  E.  Allen,  L.  A.  Viersen,  J.  L.  Ross,  W.  Harmon 
Hall,  F.  J.  Holt,  L.  G.  Jones,  Emma  T.  Reed,  Kent  Kerch  and  the 
following  laboratory  men:  Drs.  Alexander  Swab,  Frank  V.  Clayton,  S. 
A.  King,  was  held  in  the  American  National  Bank  Building.  The  class 
work  here,  in  Salt  Lake  and  in  Denver,  differed  from  that  of  the  other 
cities  in  this  respect,  that  instead  of  using  the  Gysi  ^^ Simplex''  Articula- 
tor, the  new  Hall  was  substituted.    Two  full  upper  and  lower  dentures 


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84 


THE  DENTAL  DIGEST 


were  made  for  our  patient  upon  the  Gysi  Adaptable  and  the  Hall  Articula- 
tor. In  this  manner  the  class  was  enabled  to  compare  the  relative  merits 
of  each.  One  of  the  special  features  of  this  class  was  the  construction  of 
two  casts,  pure  aluminum  bases,  one  being  swaged  upon  the  original 
Spence's  cast  (after  having  been  polished),  to  correct  the  contraction  due 
to  the  physical  properties  of  the  aluminum;  the  other  being  inserted  with- 
out this  precaution.  Needless  to  say,  the  base  which  was  not  swaged 
was  in  no  sense  a  perfect  adaptation. 

Upon  our  arrival  at  Salt  Lake  City,  we  found  the  dentists  in  a  very 
receptive  mood,  due  to  the  efforts  of  Dr.  Fred  W.  Meakin  and  my  former 


First  Row,  left  to  right:    Dr.  T.  R.  Peden;  Dr.  J.  E.  Black 

Second  Row,  left  to  right:  Dr.  W.  R.  Spencer;  Dr.  Wm.  H.  Thompson;  Dr.  D.  D. 
Campbell;  Dr.  R.  L.  Coldwell;  Dr.  P.  D.  MacSween 

Third  Row,  left  to  right:  Grant  (Patient);  Dr.  T.  W.  Snipes;  Dr.  Basil  Bayne;  Dr.  H. 
T.  Minogue;  Dr.  S.  C.  E.  Muirhead;  Dr.  H.  E.  Thomas;  Dr.  J.  W.  Henderson;  Dr.  F.  Pol- 
lock; Dr.  R.  S.  Hanna 


classmate  Dr.  Arthur  C.  Wherry.  A  class  was  soon  organized  with  the 
following  additional  members,  Drs.  R.  L.  Folsom,  A.  C.  Gartman,  W.  A. 
Marshall,  Hyrum  Bergstrom,  R.  E.  Wight,  Geo.  F.  Richards,  Jr.,  C, 
W.  Bird. 


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INFORMATION  FROM  THE  DENTAL  PROTECTIVE  ASSOCUTION      85 

Dr.  R.  E.  Wight,  in  an  unguarded  moment,  told  us  we  did  not  know 
how  to  mix  plaster  and  proceeded  to  prove  his  contention.  The  method 
is  as  follows: 

Place  the  desired  quantity  of  plaster  in  a  dry  plaster  bowl  and  instead 
of  letting  water  from  the  faucet  run  into  it,  completely  submerge  the  bowl 
and  its  contents.  Set  aside  and  watch  until  the  bubbles  cease  to  rise, 
pour  off  the  excess  of  water  and  the  mix  is  correct.  To  further  demon- 
strate that  the  affinity  of  the  plaster  for  water  has  been  satisfied,  and  that 
there  is  no  expansion,  pour  the  mix  into  a  two  ounce  glass  beaker,  the 
mix  being  perfect,  the  beaker  will  crack.     Try  it  your  way. 

The  last  class  was  held  in  Denver  with  the  following  members  en- 
rolled: Drs.  A.  Clay  Withers,  Kent  K.  Cross,  Anna  M.  Buell,  V.  Clyde 
Smedley,  J.  Larkin  Howell,  Ezra  E.  Schaefer,  Richard  C.  Hughes. 

This  class  formed  a  Campbell  Study  Club  and  has  had  two  meetings 
since  my  departure.  Reports  of  these  meetings  are  sent  to  me  with  ques- 
tions along  Prosthetic  lines.  These  are  answered  and  suggestions  made 
and  work  outlined  for  the  ensuing  month. 

In  all  of  the  classes  when  discussing  the  new  classification  of  teeth, 
stress  was  laid  upon  the  manner  in  which  teeth  should  be  selected  for 
individual  requirements.  Plane  and  autochrome  lantern  slides  were 
effectively  employed  to  show  how  in  that  much  neglected  field  of  Es- 
thetics and  Contour,  the  best  results  may  be  obtained. 

The  writer *s  judgment,  based  upon  the  general  responsiveness  with 
which  the  courses  met,  is  that  the  dentists  who  thrive  in  the  midst  of 
competition,  realize  that  they  must  master  some  method  of  Anatomical 
Articulation. 

729  Shukert  Bldg. 


IMPORTANT  INFORMATION  FROM  THE  DENTAL  PROTECTIVE 
ASSOCIATION  OF  THE  UNITED  STATES 

At  the  Annual  Meeting  of  the  Dental  Protective  Association  of  the 
United  States,  held  at  the  Hotel  La  Salle  in  the  city  of  Chicago,  on  Mon- 
day, December  20,  1915,  the  Secretary  was  requested  to  prepare  a  plain 
statement  for  publication  in  the  different  dental  Journals,  giving  such 
facts  as  would  be  of  general  interest  to  the  profession,  and  setting  forth 
the  status  of  the  members  of  the  Association  with  reference  to  the  pending 
Taggart  litigation. 

NEW  LIST  OF  MEMBERS   IN   GOOD   STANDING 

During  the  past  year  the  Board  of  Directors  revised  the  list  of  mem- 
bers, eliminating  from  the  new  mailing  list  the  names  of  those  who  were 


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86  THE  DENTAL  DIGEST 

known  to  be  dead,  out  of  practice,  or  who  did  not  pay  the  assessment 
levied  in  about  1898.  On  December  10,  191S1  the  latter  were  notified 
and  given  an  opportunity  to  place  themselves  in  good  standing  in  the 
Association  by  paying  the  $10  assessment.  A  few  took  advantage  of 
this  and  remitted  the  amount;  those  who  did  not  do  so  were  dropped 
from  the  list. 

NEXT  TO  THE  LARGEST  DENTAL  ORGANIZATION  IN  THE  WORLD 

The  new  list  of  members  in  good  standing  now  contains  the  names  of 
8,050  practicing  dentists.  These  members  are  scattered  geographically. 
A  glance  at  the  list  would  seem  to  reveal  the  fact  that  almost  every  town 
and  city  in  the  United  States  has  one  or  more  representatives  in  the 
Association.  With  the  one  exception  of  the  re-organized  National 
Dental  Association,  the  Dental  Protective  Association  of  the  United 
States  is  the  largest  Dental  Organization  in  the  world;  and  the  best 
feature  of  all  is  that  the  total  assets,  as  reported  by  the  Treasurer  at  the 
last  Annual  Meeting,  amount  to  $35,508.37.  Of  this  amount  $26,000 
is  invested  in  approved  municipal  bonds;  $6,000  is  in  individual  notes 
secured  by  a  corporation  note  for  three  times  the  amount;  and  the 
balance  is  in  ready  cash  in  a  checking  and  savings  account  in  the  North- 
ern Trust  Company  of  Chicago.  Thus  it  will  be  seen  that  the  Dental 
Protective  Association  of  the  United  States  is  a  live,  healthy  organiza- 
tion, standing  ready,  as  it  has  always  done  in  the  past,  to  defend  its 
members  against  the  unjust  demands  of  patentees  whose  claims  are 
worthless. 

THE   association's   AGREEMENT   WITH   DOCTOR   W.   H.   TAGGART 

This  brings  us  to  a  discussion  of  the  status  of  our  members  with 
reference  to  the  Taggart  litigation.  On  December  5,  1910,  the  Board  of 
Directors  of  the  Dental  Protective  Association  of  the  United  States 
recognizing  the  value  of  the  Taggart  Method  of  Casting,  after  much 
discussion  and  many  conferences,  entered  into  an  agreement  with  Doctor 
W.  H.  Taggart,  a  member  of  the  Association  in  good  standing  and  the  sole 
owner  of  certain  patents  on  this  new  and  original  method  of  making 
dental  inlays  and  the  like,  by  the  terms  of  which  members  of  the  Associa- 
tion could  obtain  the  permission  to  practice  the  Taggart  Method  of 
Casting  for  the  life-time  of  the  patents  (seventeen  years)  with  any  ma- 
chine he  may  then  be  using  for  the  cash  sum  of  $15.  This  agreement  also 
provided  that  any  member  of  the  profession  who  joined  the  Association 
within  the  time  specified  could  procure  such  permission  on  the  same  terms. 
The  time  limit  of  this  agreement  expired,  except  for  recent  graduates, 
on  February  9,  1913. 


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INFORMATION  FROM  THE  DENTAL  PROTECTIVE  ASSOCIATION      87 

STATUS   OF  RECENT  GRADUATES 

A  clause  in  the  agreement  provided  as  follows:  '^That  those  who 
entered  the  profession  within  one  year  from  the  date  of  the  first  court 
decision  sustaining  the  validity  of  patents  heretofore  mentioned  shall 
pay  $15  for  the  permission  to  practice  the  Taggart  Method  of  Casting; 
those  that  enter  the  profession  from  year  to  year  thereafter  shall  have 
the  fee  reduced  by  as  many  dollars  as  the  number  of  years  elapsed  since 
the  first  court  decision  sustaining  the  validity  of  said  patents.  One  year 
from  the  date  of  graduating  or  entrance  into  the  profession,  in  all  cases, 
shall  be  given  in  which  to  pay  the  stipulated  fee."  The  phrase  "en- 
trance into  the  profession"  has  been  interpreted  by  the  Attorney  for 
the  Association  as  meaning  that  an  individual  enters  the  profession  when 
he  takes  the  State  Board  examination,  receives  his  license  to  practice 
and  has  it  recorded,  whether  he  actually  begins  practice  at  the  time  or 
not.  This  explanation  is  here  given  for  the  benefit  of  the  many  recent 
graduates  who  are  desirous  of  information  regarding  their  standing  under 
the  terms  of  the  Association's  agreement  with  Doctor  Taggart. 

OWNERSHIP  OF  A  TAGGART  MACHINE   CARRIES   WITH  IT  THE  PERMISSION 

TO   USE   THE   METHOD 

During  the  time  from  December  5,  19 10  to  February  9,  19 13,  when 
the  terms  of  the  agreement  were  open  to  not  only  our  members,  but  to 
the  entire  profession,  there  were  over  4,200  practicing  dentists  who 
availed  themselves  of  the  terms  and  paid  the  $15.  At  this  time  Doctor 
Taggart  was  offering-  his  casting  machine  for  sale.  This  could  be  pur- 
chased through  the  Association  for  $75  cash,  or  direct  for  $100  cash.  A 
great  many  of  our  members  purchased  the  machine  direct  from  Doctor 
Taggart  before  the  agreement  was  made;  a  few  subsequently  purchased 
it  through  the  Association.  A  considerable  number  of  dentists,  who  were 
not  members  of  the  Association,  also  purchased  the  machine  direct. 
The  right  to  use  the  Taggart  Method  of  Casting  went  with  the  purchase 
of  a  machine  from  whatever  source;  and  the  ownership  of  a  machine 
to-day  carries  with  it  the  permission  to  use  the  Method.  This  informa- 
tion is  given  and  emphasized  here  for  the  benefit  of  those  dentists  who 
own  a  Taggart  Casting  Machine.  Those  of  our  members  who  purchased 
the  machine  must  remember  that  whoever  owns  the  machine  to-day,  no 
matter  where  or  how  it  was  purchased,  holds  the  sole  right  to  use  the 
Method.  In  other  words  a  machine  cannot  be  sold  to  another  and  the 
former  owner  retain  the  privilege  of  using  the  Method. 

STATUS   OF   MEMBERS   IN   TAGGART   LITIGATION 

This  question  is  frequently  asked:  Where  does  the  individual  stand, 
with  reference  to  the  pending  Taggart  litigation,  who  is  a  member  of 


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88  THE  DENTAL  DIGEST 

this  Association  in  good  standing  and  who  did  not  accept  the  terms  of  the 
agreement  with  Doctor  Taggart  before  the  time  limit  expired?  In  reply 
to  this  important  question,  we  will  say  that  every  member  was  notified 
individually  and  through  the  Dental  Journals,  not  only  once  but  several 
times,  of  the  opportunity  afforded  by  the  terms  of  the  agreement;  and 
those  who  did  not  Siccept  forfeiled  their  right  to  protection,  from  this  source 
by  this  Association,  They  are  hereby  so  notified  that  they  may  either 
settle  direct  with  Doctor  Taggart  or  make  whatever  other  arrangements 
they  see  fit  to  protect  themselves  from  the  Taggart  patents. 

The  question  has  also  been  raised  as  to  the  right  of  a  member  of  this 
Association,  who  did  accept  the  terms  of  the  agreement  with  Doctor 
Taggart,  to  join  other  Associations  organized  primarily  to  fight  Doctor 
Taggart.  Every  member  of  the  Dental  Protective  Association  of  the 
United  States  who  accepted  the  $15  proposition,  agreed  by  signing  the 
by-laws,  to  abide  by  the  same.  Under  Section  XIII  of  said  by-laws,  the 
third  paragraph  reads  as  follows:  "If  said  $15  be  paid  before  the  entry 
of  any  decree  or  judgment  finding  any  of  Doctor  Taggart's  patents  men- 
tioned above  in  said  agreement  valid  or  granting  damages  for  infringe- 
ment thereof,  the  member  is  free  to  practice  the  Method  with  any  machine 
he  may  then  be  using,  and  after  the  date  of  said  decree  or  judgment,  the 
member  is  not  to  purchase  or  use  machines  infringing  Doctor  Taggart's 
machine  patents,  except  as  aforesaid,  and  no  member  of  the  Association  is 
to  defend  or  join  in  or  contribute  to  the  defense  of  any  suit  upon  any  of  said 
patents  while  practicing  the  Method  under  such  permission  from  Doctor 
Taggart,''  In  this  connection  it  may  be  stated  that  this  agreement 
with  Doctor  Taggart  was  no  voluntary  effort  on  his  part;  and  after  he 
finally  consented  to  what  he  felt  was  practically  giving  the  method  away 
($15  for  17  years  amounts  to  about  88  cents  a  year)  he  demanded  this 
clause  on  the  contention  that  he  would  not  grant  a  man  the  right  to  use 
the  Method  for  practically  nothing  and  leave  him  free  to  contribute 
several  times  the  amount,  if  he  so  desired,  to  defeat  him  in  court  of  his 
just  due.  The  Board  of  Directors  recognized  the  justice  of  this  demand 
and  consented  to  it.    Thus  this  question  is  answered  here  in  full. 

MAY   DENTISTS   NOW  JOIN   THIS   ASSOCIATION? 

It  is  frequently  asked  if  the  doors  of  the  Dental  Protective  Association 
of  the  United  States  are  now  closed  to  the  profession,  or  if  members  of  the 
profession  may  join  at  this  time.  In  reply  to  this  question  we  will  say 
that,  subject  to  the  approval  of  the  Board  of  Directors  any  member  of 
the  Dental  Profession  may  become  a  member  of  the  Association  on  pay- 
ment to  the  Treasurer  of  a  membership  fee  of  $10,  and  subscribing  to  the 
by-laws  of  the  Association;  but  it  must  be  with  the  distinct  understand- 


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INFORMATION  FROM  THE  DENTAL  PROTECTIVE  ASSOCIATION      89 

ing  that  the  time  limit  of  the  agreement  with  Doctor  Taggart  has  expired, 
except,  as  previously  mentioned,  for  recent  graduates  or  those  who  have 
not  been  in  the  practice  of  dentistry  for  more  than  one  year. 

WHY  DENTISTS  ARE  JOINING  AT  THIS   TIME 

Though  no  immunity  can  be  offered  by  this  Association  at  this  time 
from  Doctor  Taggart,  except  to  recent  graduates;  nevertheless,  dentists 
are  joining  the  Association  for  the  protection  afforded  from  other  sources. 
There  has  scarcely  been  a  time  since  1888,  when  the  Dental  Protective 
Association  of  the  United  States  was  first  organized,  when  the  Association 
has  not  had  pending  more  or  less  patent  litigation.  It  has  been  success- 
ful in  all  of  its  suits  to  date.  There  must  be  a  reason  for  this.  We  believe 
it  is  due  to  the  fact  that  the  Association  was  organized  on  the  right  basis; 
for  the  sole  purpose  of  defending  its  members  against  abuse  by  patentees 
whose  claims  were  worthless,  and  not  to  defraud  any  man  of  his  just  due. 
The  United  States  Government,  through  its  patent  ofl5ce,  grants  patents 
to  individuals  whom  it  believes  have  something  worthy,  new,  and  original. 
In  this  manner  it  encourages  inventive  genius.  It  would  be  wrong  for 
any  Association  to  attempt  to  fight  all  patents,  dental  or  otherwise, 
regardless  of  their  merit.  Such  is  not  the  policy  of  the  Dental  Protective 
Association  of  the  United  States;  but  let  it  be  remembered,  thai  it 
stands  to-day^  as  it  has  stood  for  nearly  twenty-eight  years j  like  a  stone  wall 
between  its  members  and  patent  abuse. 

At  the  present  time  the  Association  is  defending  one  of  its  members 
who  has  been  sued  for  infringing  a  patent  on  a  set  of  instruments  for 
scaling  teeth.  In  the  opinion  of  the  Board  of  Directors  the  principle 
involved  in  the  patent,  and  on  which  it  is  based,  is  neither  new  nor 
original;  and  they  felt  that  it  would  be  dangerous  for  the  members  and 
the  profession  to  have  said  patent  validated  in  court.  Therefore,  they 
have  directed  the  attorney  to  assume  full  defense  of  the  suit  on  behalf  of 
the  Association. 

In  this  brief  article  we  have  endeavored  to  cover  and  explain,  so  far 
as  possible,  all  points  which  may  arise  now  that  the  Taggart  and  other 
litigation  is  pending,  in  order  to  thoroughly  inform  the  membership  of 
the  Association,  and  incidentally  others  in  the  profession  who  may  be 
interested;  and  to  avoid  unnecessary  correspondence.  However,  should 
anyone  want  further  information  or  desire  to  join  the  Association,  they 
may  address  the  Secretary,  39  South  State  Street,  Chicago,  111. 

Byorderof  the  Board  of  Directors:  J.  G.  Reed,  President. 

J.  P.  Buckley,  V.-Pres.  &  Sec'y. 


D.  M.  Gallie,  Treasurer. 


Chicago,  January  4,  1916. 


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DEDICATION  OF  THE  MILLER  MEMORIAL  MONUMENT 

The  Ohio  State  Dental  Society  Meeting  for  191 5  was  one  of 
especial  interest  as  it  was  the  scene  of  the  Dedication  of  the 
Miller  Memorial  Statue,  a  monument  raised  by  the  united 
eflforts  of  the  dental  societies  of  Ohio,  though  nearly  every  state 
contributed  to  this  monument.  The  statue  is  situated  near  the 
library  building,  on  the  campus  of  the  Ohio  State  University. 

The  memorial  was  unveiled  by  Miss  Annie  Brooks,  of  Alex- 
andria, Ohio.  The  assembly  afterward  gathered  in  the  chapel 
of  the  university  where  an  address  was  delivered  by  Dr.  E.  C. 
Kirk,  Philadelphia;  remarks  were  also  made  by  Dr.  T.  W. 
Brophy,  Chicago;  Dr.  N.  S.  Hoff,  Ann  Arbor;  Dr.  Thos.  P. 
Hinman,  Atlanta;  Prof.  G.  W.  Knight,  of  the  Ohio  State 
University  and  by  others. 

Dr.  Miller  was  born  August  i,  1853  near  Alexandria,  Ohio. 
He  entered  the  University  of  Michigan  the  fall  of  1871  and  took 
his  degree  of  Bachelor  of  Arts  June,  1875.  Deciding  to  adopt 
as  his  profession  that  of  mathematical  physics — he  went  to 
Scotland  and  studied  in  the  Edinburgh  University  under  Sir 
William  Thomson.  His  health  failing  him  through  over-work, 
he  sought  rest,  and  it  was  during  this  period  of  recuperation  that 
he  met  in  Berlin,  Dr.  F.  P.  Abbot,  who  was  the  representative 
American  dentist  in  that  city.  It  was  through  Dr.  Abbot's 
influence  that  he  decided  to  return  to  America  and  take  the 
dental  course,  graduating  from  the  University  of  Pennsylvania 
in  1879. 

Later  he  was  called  to  accept  the  office  of  Dean  of  the 
Dental  Department  of  the  University  of  Michigan. 

He  practised  abroad  extensively  as  well  as  wrote  volumin- 
ously, being  the  author  of  over  one  hundred  books,  and  articles 
on  every  phase  of  dentistry. 

A  year  previous  to  his  death,  Kaiser  Wilhelm  had  conferred 
upon  him  the  rank  of  priv>'^  medical  councilor. 


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STATUE  OF  DR.  WILLOUGHY  DAYTON  MILLER 


Born,  August  i,  1853.    Died,  July  27,  1907 


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92  THE  DENTAL  DIGEST 

CORRESPONDENCE 

Editor  Dental  Digest: 

(In  answer  to  L.  B.  Brown  October  Digest,  page  632).  If  Cookville, 
Tenn.,  is  as  hot  a  place  as  some  parts  of  Australia,  it  is  quite  possible 
that  the  worm  arrived  in  that  tooth  per  medium  of  a  blow  fly. 

Some  years  ago  I  was  practicing  in  a  town  that  was  very  hot  and  where 
the  above  fly  was  a  pest.  One  day  I  had  extracted  a  tooth  and  laid  it 
down  while  I  did  something  else,  probably  to  console  the  patient.  I  was 
young  at  the  time  and  perhaps  nervous,  but  my  astonishment  was  great 
when  on  going  to  remove  the  tooth  out  of  sight  I  saw  a  worm  in  the 
cavity  and  one  on  the  root. 

For  days  I  began  to  wonder  if  the  gentleman  was  right  who  traveled 
selling  pills  that  you  "  simply  placed  in  your  decayed  tooth  which  removed 
the  worm  that  caused  decay  and  toothache.'' 

It  was  sometime  before  I  thought  of  the  above  explanation. 
I  am  yours  sincerely, 

J.  Kempthorne, 
Atherton,  Marrickville,  N.  S.  W.,  Australia. 

ANSWER  TO  G.  F.  LOGAN,  D.D.S.* 

Books  on  pathology  and  surgery  recognize  two  causes  of  disease, 
namely,  predisposing  and  exciting.  Dr.  Logan  recognizes  only  one, 
therefore  he  is  wrong.     {See  Items  of  Interest^  December,  1915). 

Dr.  Logan  states  that  we  all  know  that  tartar  is  not  the  cause  of 
pyorrhea.  Now  I  have  never  seen  a  case  of  pyorrhea  where  tartar  was 
not  present  or  had  been  present  long  enough  to  cause  the  pyorrhea;  but 
some  dentists  do  not  find  it  and  therefore  say  it  is  not  present. 

I  have  a  patient  who  had  been  treated  for  pyorrhea  and  at  the  last 
visit  he  made  to  his  former  dentist,  he  told  the  patient  he  did  not  have 
any  tartar  on  his  teeth;  two  days  after  the  last  visit  to  his  former  den- 
tist he  applied  to  me  for  treatment  and  I  found  sanguinary  tartar  (hard 
brown  tartar)  under  the  gum  on  ten  or  eleven  of  his  teeth.  If  pyorrhea 
is  caused  by  tartar,  tartar  must  be  the  cause  of  pyorrhea. 

If  tartar  is  not  the  cause  what  is  the  use  of  removing  the  tartar  to 
cure  the  pyorrhea  or  before  curing  pyorrhea  why  not  cure  the  pyorrhea 
then  remove  the  tartar?  It  is  not  ix)ssible.  I  have  never  seen  a  case 
of  pyorrhea  alleviated  to  any  extent  or  cured  where  tartar  was  present, 
and  that  should  be  proof  enough  that  tartar  is  the  cause  of  pyorrhea. 

Tartar  is  the  cause  of  expulsive  gingivitis.    I  do  not  like  the  word 

•Items  of  Interest,  Dec.,  1915. 


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CORRESPONDENCE  93 

pyorrhea  as  it  is  generally  used,  as  expulsive  gingivitis  is  a  better  term. 
Many  dentists  use  the  word  pyorrhea  whether  pus  is  present  or  not. 
Now  I  believe  pus  must  be  present  to  use  the  word  pyorrhea  properly. 

C.  Wayne  Mingle,  D.D.S., 
December  26,  1915  731  W.  Erie  Ave.,  Philadelphia,  Pa. 

Editor  Dental  Digest: 

I  should  like  to  inquire  of  you  through  the  Digest,  what  foundation, 
in  fact,  there  is  for  the  current  rumor  that  conductive  anesthesia  of  the 
mandible  is  apt  to  result  in  permanent  anesthesia  of  some  of  the  parts. 

I  am  perfectly  familiar  with  the  answer  that  Thoma  and  Fischer  give 
to  this  question,  but  somehow  I  keep  hearing  of  dentists  who  have  heard 
that  a  friend  of  a  friend's  friend  had  such  a  case. 

Do  you  suppose  that  such  rumors  have  been  passed  along  by  dentists 
who  did  not  possess  the  skill  or  the  nerve  to  employ  conductive 
anesthesia? 

Do  you  think  that  sufficient  time  has  elapsed  since  the  introduction 
of  this  method  to  make  the  judgment  of  Thoma  and  Fischer  absolutely 
authoritative  and  final  on  this  point? 

Yours  very  truly, 

A. 

Editor  Dental  Digest: 

On  page  8  of  the  January  Digest  the  question  is  asked,  *'What  is 
the  best  thing  to  do  for  a  child  three  years  old  who  breathes  through  the 
mouth  nights  and  snores  as  loud  as  an  adult?    W.  B.  B." 

Ttike  two  strips  of  surgeon's  plaster,  f  in.  wide  and  i  in.  long,  have 
her  turn  the  lips  in,  close  the  mouth  tight,  stick  the  two  strips  on  each 
side  of  centre,  sealing  the  mouth  tight  so  she  will  breathe  through  the 
nose.  In  the  morning  take  hold  of  one  comer  and  pull  the  plaster  off. 
This  metliod  continued  nights  for  several  years  will  form  the  habit  of 
correct  breathing  and  prevent  the  cHld  from  having  colds  every  few 
days.  Nine  tenths  of  the  colds  children  have  can  be  prevented  by  this 
process.     The  child  will  sleep  better  and  enjoy  better  general  health. 

Levi  C.  Taylor, 
Hartford,  Conn. 


Editor  Dental  Digest: 

Can  you  inform  me  what  to  put  into  an  electric  sterilizer  to  keep 
the  investment  from  rusting? 

B.  F.  M. 


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fTINE/y^VILDING 


**Nothing  but  the  very  best  of  instru- 
ments and  materials  can  give  your  ability 
the  assistance  it  deserves." — Selected. 


THE  BUSINESS  SIDE  OF  PROPHYLACTIC  AND 
RESTORATIVE  PRACTICE* 

By  W.  F.  Spies,  D.D.S.,  and  George  Wood  Clapp,  D.D.S.,  New  York 

SECOND  PAPER 
AVERAGE  INCOME  HOUR  FEES 

Analysis  of  reports  from  a  considerable  number  of  dental  practices 
in  different  parts  of  the  United  States  seems  to  show  that  the  following 
minimum  fees  are  necessary  for  each  of  i,ooo  annual  income  hours  to 
maintain  these  practices  in  their  present  conditions.!  These  fees  are 
exclusive  of  the  costs  of  teeth  and  precious  metals. 

$1.45 
2.22 

3  13 

3  94 
4.89 

DIFFERENT   FORMS   OF   SERVICE 

The  forms  of  dental  service  concerning  which  we  are  able  to  offer 
time  reports  and  income-hour  costs  for  different  classes  of  practice  include 
the  more  common  forms  of  service  comprised  under  the  general  headings 
Prophylaxis  and  Restoration,  and  thus  include  treatment  of  inflammation 
of  the  soft  tissues  surrounding  the  teeth,  repair  of  decayed  teeth  and 
replacement  of  missing  teeth.  No  figures  are  offered  for  the  operations 
of  orthodontia,  oral  surgery  and  full  denture  making. 

PROPHYLACTIC   PRACTICE 

The  word  prophylaxis  means  ''prevention"  and  prophylactic  ser\dce 
in  dentistry  is  devoted  to  preventing  inflammation  of  the  soft  tissues 
and  decay  of  the  teeth.  Obviously  the  best  way  to  prevent  further 
encroachment  is  to  remove  the  causes  of  the  pathological  conditions. 

*This  article  began  in  the  January,  191 6,  number. 

tThese  figures  are  taken  from  the  forthcoming  book  "Profital)le  Practice." 


Class 

I 

Practices 

Class 

II 

Practices 

Class 

in 

Practices 

Class 

IV 

Practices 

Class 

v 

Practices 

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PROPHYLACTIC  AND  RESTORATIVE  PRACTICE  95 

Probably  the  commonest  and  simplest  manifestation  of  a  pathological 
condition  of  the  soft  tissues  surrounding  the  teeth  is  first  seen  as  a  slight 
reddening  of  the  free  margins  of  the  gums.  If  this  condition  is  rightly 
diagnosed  it  usually  responds  readily  to  proper  treatment.  If  the  causes 
are  not  removed,  and  proper  treatment  instituted,  the  inflammation 
progresses  with  resulting  loss  of  the  tissues  surrounding  the  teeth  and 
final  loss  of  the  teeth. 

Prophylactic  dental  service  comprises  the  removal  of  deposits  upon 


Fig.  I.    An  illustration  of  a  beginning  case  of  Pyorrhea 

the  teeth,  polishing  the  teeth,  medicinal  aid  to  the  soft  tissues  and  the 
mstitution  of  intelligent  home  treatment  by  the  patient. 

SIMPLE   PROPHYLACTIC   CASES 

Simple  prophylactic  cases  present  inflammation  of  the  margins  of 
the  gums  due  to  the  presence  of  deposits  about  the  necks  of  the  teeth. 
They  are  cases  which  a  **  cleaning ''  has  usually  been  expected  to  relieve. 
The  great  trouble  has  generally  been  that  the  importance  of  the  inflam- 
mation has  been  underestimated  and  the  '^cleaning"  has  been  insufii- 
ciently  thorough. 

If  the  standard  of  this  form  of  professional  service  be  the  removal  of 
all  irritants  which  caused  the  inflammation,  and  the  polishing  of  all 
surfaces  of  all  teeth  to  a  condition  which  renders  them  acceptable  to 
the  soft  tissues  and  protects  them  against  decay  of  the  enamel,  it  may 


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96  THE  DENTAL  DIGEST 

be  asserted  that  proper  prophylactic    service   cannot  be   rendered    in 
the  short  time  usually  devoted  to  a  ** cleaning/' 

The  following  reports  are  from  the  records  of  cases  at  the  Pyorrhocide 
Clinic.  The  work  was  performed  by  different  operators  who  naturally 
work  at  different  speeds,  and  the  averages  are  probably  very  close  to  the 
time  that  would  be  required  by  a  dentist  of  moderate  speed  who  had 
instructed  himself  in  the  proper  technic.    The  treatment  of  all  these 


Fig.  2.    An  intermediate  case  of  Pyorrhea 

cases  was  identical.  It  consisted  of  removal  of  deposits  by  instrumenta- 
tion, of  polishing  by  means  of  wood  points  and  a  polishing  medium,  and 
an  average  of  5  applications  of  Dentinol. 

Thirty-one  simple  cases  required  from  i  to  6  hours  each  with  a  total 
of  131  hours  and  an  average  of  4  hours  and  20  minutes,  divided  into 
sittings  of  about  30  minutes  each. 

The  cost  of  these  treatments  involves  the  overhead  charges,  the 
remuneration  and  the  cost  of  materials,  except  precious  metals. 

The  cost  of  these  treatments  to  the  dentist  may  be  tabulated  as  follows: 

Minimum  Class  I 

Hourly  fee $1  45 

Total  cost 6.30 

INTERMEDIATE   CASES 

In  intermediate  cases  the  inflammation  is  more  extensive  than  in 
simple  cases,  there  is  infection  and  pus  flow  and  some  pocket  formation, 


Class  II 

Class  III 

Class  IV 

Class  V 

$2.22 

S  S'^S 

$  3-94 

$4.89 

9.60 

13. 55 

1705 

21.20 

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PROPHYLACTIC  AND  RESTORATIVE  PRACTICE 


97 


but  the  teeth  have  not  been  loosened  beyond  the  power  of  again  becoming 
firm  without  splinting. 

The  treatment  was  identical  in  character  with  that  in  the  simple 
cases  except  that  more  time  was  required  for  each.  Seventy-nine  cases 
required  a  total  of  742  hours,  with  an  average  of  9  hours,  25  minutes 
divided  into  numerous  sittings. 

The  costs  in  these  cases  would  be  as  follows: 

Minimum  Cls 

Hourly  fee $1 

Total  cost 


5l 

Class  II       Class  III 

Class  IV 

Class  V 

•45 

$  2.22          $  3.13 

S  3  94 

$4.89 

•70 
^DVA 

20.90            29.48 
.NCED   CASES 

37.10 

46.15 

Advanced  cases  are  marked  by  considerable  amounts  of  extensive 
pocket  formation  and  pus  flow,  and  loss  of  the  soft  and  hard  tissues  sup- 
porting the  teeth,  so  that  the  teeth  are  often  too  loose  to  again  become  firm 
without  splinting. 


Fig.  3.    An  advanced  case  of  Pyorrhea 

Nine  advanced  cases  in  which  the  teeth  were  not  splinted  were 
treated  in  the  same  manner  as  the  simple  and  intermediate  cases,  but 
required  a  total  of  189  hours,  or  21  hours  each.  The  costs  of  these  cases 
would  be  as  follows; 


Minimum 

Class  I 

Class  n 

Class  in 

Class  IV 

Class  V 

Hourly  fee      .     .     . 

.  '  .      $  1.45 

$  2.22 

$  3.13 

$  3.94 

$4.89 

Total  cost      .     .     . 

30.45 

46.60 

65.75 

83.74 

102.69 

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98  THE  DENTAL  DIGEST 

Twenty  advanced  cases  requiring  prophylactic  treatment  and  splints 
required  a  total  of  420  hours  at  the  chair,  an  average  of  21  hours;  a  total 
of  96  hours  of  laboratory,  an  average  of  4  hours  48  minutes  per  case;  and 
a  total  cost  for  precious  metal  and  teeth  of  $369.25,  an  average  cost  of 
$18.45  P^r  case. . 

In  the  following  table,  the  laboratory  time  is  estimated  at  the  same 
cost  as  chair  time. 


Minimum  Class  I  Class  II  Class  III        Class  IV          Class  V 

Hourly  fee $  i.4S  $2.22  %  3-^3           $3  94            $489 

Chair  time 30. 45  46.60  65. 

Laboratory  time  ....  6.95  10.65  15. 

Materials 18.45  18.45  18. 

Total  cost 55.85  75.70  99. 

To  be  continued. 


75  83.75  102.70 

00  18.90  23.45 

45  18.45  18.45 

20  1 21. 10  144  60 


WHAT  I  THINK  INLAYS  COST 
By  F.  D.  H..  Lampasas,  Texas 

(Discussing  the  answers  to,  **  What  will  it  cost  you  to  fill  this  tooth.'') 
In  the  December  issue  of  the  Digest,  in  answer  to,  **  What  will  it  cost 
you  to  fill  this  tooth,"  there  are  published  nine  answers,  with  estimated 
costs  running  from  $3.70  to  $13.  As  each  of  these  estimates  seem  to  be 
figured  very  closely,  and  as  there  is  such  a  wide  difference,  it  must  mean 
that  there  is  a  fallacy  somewhere  and  that  when  it  comes  to  actual  cost 
we  are  all  up  in  the  air,  and  any  kind  of  a  guess  would  be  more  accurate 
than  these  figures.  It  is  easy  enough  to  tell  what  an  operation  has  cost 
us  after  it  is  done,  but  it  is  impossible  to  tell  what  it  will  cost  before  it  is 
done.  Not  one  of  these  answers  take  into  consideration  the  possibility  of 
a  failure  in  casting  or  fitting,  and  I  am  sure  we  all  have  them.  Quite 
recently  I  had  six  large  inlays  of  about  an  equal  size  and  accessibility  to 
insert,  five  of  them  were  put  in  with  very  little  trouble,  but  the  sixth  was 
cast  four  times  before  I  was  satisfied.  Now,  according  to  the  estimates 
published,  I  should  charge  several  times  as  much  for  the  sixth  inlay  as 
any  of  the  others.  There  are  many  cases  where  more  time  is  consumed 
in  filling  in  a  very  small  inlay,  than  one  that  is  much  larger,  but  the  pa- 
tient does  not  take  this  into  consideration,  and  we  cannot  get  as  much  for 
it.  The  prize  answer  has,  as  an  item  of  expense,  $1,200  for  dental  mech- 
anic; this  should  not  properly  be  considered,  as  this  department  should 
be  self-sustaining;  but  if  this  is  considered,  how  can  we  say  which  is  pay- 
ing the  $3  or  $5  an  hour,  the  laboratory  or  the  chair?    It  is  possible  that 


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PROPHYLACTIC  AND  RESTORATIVE  PRACTICE  99 

the  laboratory  man  is  losing  money  for  us,  if  so,  our  charges  must  be 
increased  in  proportion.  The  prize  answer  figures  fifty  minutes  for 
investing,  dehydrating  and  casting;  all  this  should  take  only  about  ten 
minutes  of  actual  time  consumed,  as  the  waiting  time  might  be  profitably 
used  for  something  else.  The  time  of  a  man  qualified  for  manual  labor 
only,  is  worth  something  like  twenty-five  cents  an  hour;  but,  should  he 
spend  several  years  at  college,  costing  him,  including  the  time  spent, 
$3,000,  he  is  then  in  a  position,  by  his  superior  knowledge,  to  earn,  say 
$3  an  hour.  If  this  $3,000  is  considered  in  this  estimate  of  expense,  and 
time  still  put  at  $3  an  hour,  there  is  a  doubling  up,  and  we  are  making 
the  patient  pay  for  the  money  spent  which  enabled  us  to  charge  him  for 
such  valuable  time.  Again,  if  we  put  $3,000  for  college  work,  we  should 
also  include  time  and  money  spent  for  preliminary  education,  as  without 
this  we  could  not  get  the  college  work.  Also  ones  wearing  apparel  is  just 
as  necessary  an  item  of  expense  as  magazines.  This  course  of  logic  can 
be  carried  on  indefinitely,  but  it  seems  to  me,  that  more  of  these  things 
should  be  considered,  save  what  our  time  is  actually  worth,  considering 
that  we  have,  by  preliminary  work  and  expense,  made  it  valuable. 
Brother  Bill  or  father,  has  already  settled  for  these  preliminary  items,  and 
we  have  repaid  him  in  love  and  affection  and  the  account  is  closed.  The 
question  now  is:  what  will  this  filling  cost  us  as  we  are  now  situated? 
Burying  the  past,  looking  to  the  future,  we  start,  with  our  present  quali- 
fications, to  clear  $3,000  a  year.  We  examine  the  cavity,  but  are  unable 
to  say  what  time  will  be  required  to  fix  it,  we  estimate  the  time  from 
previous  records,  and  place  it  at  ninety  minutes  of  actual  work,  upon  the 
basis  of  one  thousand  producing  hours  a  year.  To  earn  the  three  thous- 
and dollars,  each  hour  must  bring  us  in  $3.  But  from  an  actual  record 
of  oflSce  expenses,  let  us  place  the  figure  at  $1,000;  (It  does  not  cost  me 
nearly  so  much  and  I  have  a  larger  than  a  $3,000  practice).  Upon  this 
basis  we  should  get  $4  an  hour  for  our  work,  or  $6  for  completing  the  in- 
lay; in  my  opinion,  about  the  amount  an  average  person  will  stand  for 
such  work  without  kicking. 


Facilities  in  Removing  Teeth  from  a  Rubber  Plate. — Put  the 
plate  in  boiling  water,  keep  it  there  for  five  minutes  while  boiling.  You 
will  then  find  the  rubber  soft  and  easy  to  remove  the  teeth  with  any 
pointed  tool.  While  secured  from  cracking,  they  are  removed  thor- 
oughly clean  from  rubber. 

Brooklyn  Dental  Laboratory. 


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100  TH£  DENTAL  DIGEST 


DENTISTRY  FROM  A  HNANCIAL  ASPECT* 
By  Percy  A.  Ash,  D.D.S. 

EdUor  ^* Commonwealth  Denial  Review,'*  Lecturer  and  Examiner  University  of  Sydney,  Etc. 

When  your  Hon.  Secretary  conveyed  to  me  your  very  kind  invitation 
to  read  a  paper  before  this  Society,  he  suggested  the  subjects  of  finance 
and  dental  jurisprudence,  from  which  I  gathered  that  you,  like  the  great 
majority  of  dental  practitioners,  are  pleased  to  hear  something  occasion- 
ally a  little  off  the  beaten  track  of  technical  and  scientific  dentistry.  I 
regard  it  as  a  great  compliment  that  you  think  me  capable  of  writing  an 
interesting  article  upon  such  subjects,  but,  as  the  time  at  my  disposal 
must  of  necessity  be  limited,  I  shall  leave  the  question  of  dental  juris- 
prudence quite  out  of  consideration,  and  deal  with  financial  affairs.  Per- 
haps, in  order  to  justify  myself,  I  should  repeat  that,  before  taking  up  the 
study  of  dentistry,  I  spent  six  years  in  banking  and  commercial  pursuits, 
and  subsequently  went  through  four  years  in  law  as  a  duly  articled  clerk 
to  a  solicitor,  during  which  time  I  had  opportunity  of  becoming  well  ac- 
quainted with  both  the  practical  and  theoretical  aspects  of  money  matters 
as  well  as  with  the  legal  position  in  relation  thereto. 

In  trying  to  decide  what  line  of  argument  would  prove  most  attractive 
to  you,  I  have  been  greatly  help)ed  by  some  letters  I  received  from  dentists 
after  the  publication  of  my  series  of  articles  on  **  Financial  investments." 
Among  the  many  requests  which  came  to  hand,  four  appealed  to  me  more 
than  others,  and  I  thought  I  could  not  do  better  than  confine  my  remarks 
to  them  this  evening.    They  are: — 

1.  Can  you  tell  me  how  to  succeed  in  practice? 

2.  If  you  write  again  on  matters  of  finance,  will  you  set  out  the 
advantages  of  keeping  a  bank  account,  and  also  let  us  have  some  definite 
information  as  to  why  cheques  are  "crossed,"  the  word  "bearer"  struck 
out,  etc. 

3.  Explain  to  us,  if  you  can,  how  some  men  who  have  money  to  lend 
receive  high  rates  of  interest  on  good  securities. 

4.  Will  you  give  us  a  method  of  book-keeping  whereby  we  can  as- 
certain at  any  time  just  how  we  stand  financially? 

Any  one  of  these  requests  involves  a  subject  large  enough  to  occupy 
an  evening,  but  as  they  are  all  very  important,  I  shall  endeavor  to  say  a 
little  upon  each.    The  most  difficult  one  to  answer  is  No.  I. 

*  (Read  before  the  Odontological  Society  of  Victoria,  Sydney,  Australia.) 


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DENTISTRY  FROM  A  FINANCIAL  ASPECT  101 

HOW  TO   SUCCEED  IN   PRACTICE 

We  may  safely  assume  that  the  person  who  asked  this  question  had  in 
his  mind  the  monetary  asj)ect  of  dentistry.  We  are  forced  to  admit  that, 
in  the  commercial  age  in  which  we  live,  a  man^s  success  in  life  is  deter- 
mined largely  by  the  amount  of  money  he  makes.  Though  it  is  fre- 
quently very  difficult  to  accomplish  much  without  money,  still  the  acqui- 
sition of  it  must  not  be  looked  upon  as  the  main  aspiration  of  human 
existence.  What  man  of  any  genuiiie  spirit  want;?  to  befcome  rich  through 
the  beneficence  of  other  people?  What  tind'of  ^^  mind  is  it  which  is  al- 
ways craving  for  a*  substantial  legacy- under  ^scme  wealthy  pcrson^s  will, 
or  for  a  windfall  frbrh-somewhei'e/v/hidh' will-  enaiile  him  ttt  live  in 'ease, 
without  the  expenditure  ofd  Fca^onatile  ^.nfount  o!  {ihtsical*  and  mental 
energy?  No  man  with  arr^bition  Of  th5  right -sort  hofi^es  for  finahcidl  gain 
on  such  terms;  he  desires  to  work  for  what  he  gets,  to  make  his  money 
off  his  own  bat,  so  to  sj)eak,  and  to  honestly  accumulate  enough  during 
his  years  of  health  and  strength  to  see  him  through.  Within  the  limits  of 
our  own  profession,  some  of  us  may  be  high-minded  enough  to  regard  as 
successful  anyone  who  has  made  a  valuable  contribution  to  the  sum  total 
of  scientific  knowledge,  or  who  has  reached  the  position  of  a  prominent 
teacher  in  a  reputable  university  or  college,  but,  so  far  as  the  average  man 
on  the  street  is  concerned,  success  in  a  professional  or  business  calling  is 
measured  in  money.  Taking  that,  then,  as  the  correct  interpretation 
of  my  correspondent's  enquiry,  I  shall  set  out  on  the  rather  thankless  task 
of  instructing  others  how  to  conduct  their  own  business,  and  in  the  effort, 
it  will  be  necessary  to  mention  many  commonplace  details,  which,  though 
apparently  insignificant,  have  to  be  reckoned  with  in  the  practice  of  den- 
tistry where  the  personal  equation  is  so  much  in  evidence. 

When  you  are  asked  to  advise  another  how  to  succeed,  the  greatest 
difficulty  you  encounted  is  an  insufficient  knowledge  of  the  qualities  of  the 
person  seeking  your  help.  If  you  have  been  successful  yourself  (presum- 
ing, of  course,  that  you  have  always  been  honest),  you  naturally  dilate 
on  the  many  elements  which  have  contributed  to  that  end;  but,  more 
than  likely,  as  you  proceed,  you  will  discover  that  your  enquirer  lacks 
most  of  the  qualifications  which  you  have  found  indispensable.  It  may 
be  that  some  practitioner,  whose  career  you  have  watched  for  years,  will 
ask  your  advice;  you  know  from  experience  why  he  has  failed,  but  yet  you 
hesitate  to  say  so.  For  instance,  it  requires  much  courage  to  tell  him  that 
he  lacks  refinement,  but  yet  you  feel  that  there- in  chiefly  lies  the  reason 
of  his  failure.  There  is  no  occupation  that  I  know  of  -not  excluding 
medicine — where  a  good  manner  counts  for  so  much  as  in  dentistry,  and 
by  this  I  mean  a  manner  that  is  inborn  and  not  assumed,  for  the  real 
is  very  readily  distinguishable  from  the  imitation,  by  people  of  gentle 


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102  THE  DENTAL  DIGEST 

birth.  The  fact  is  that  very  many  of  us  in  life  are  misfits;  some  in  the 
profession  should  be  at  something  which  calls  for  more  muscle  and  less 
brains;  some  who  are  in  commercial  enterprises  lack  the  necessary  quali- 
fications to  stand  up  against  the  keen  competition  in  that  class  of  business; 
some  are  born  to  follow  and  not  to  lead,  and  hence  should  be  in  positions 
where  there  is  always  a  head  to  refer  to. 

H.  Y.  Braddon,  in  his  book  on  "Business  Principles  and  Practice/' 
touching  on  thia  feafiir^  of^J^ujuan  activity,  says: — "In  point  of  fact,  in 
the  large  concerrff  the  j^tOrlajax^r;  banks,  companies  or  other,  there  is  al- 
'.  wajiS;rc)Qii^at.tbe  top..  .JQne  of  the  depre^sipg  features  of  business  is  the 
V'^elatc^d^OacrgHniviilJef.tff  felfiricd  torlers.who  ^X  UJ>^Jt$jd  by  temperament 
or  lack;Qf.jTi«i:ital  iiccoutremenj:,  X^  g^l  YP/y.  ff^r.  Then,  too,  there  are 
those.  (iWsV.h^TOily •'fewer,  rwio  stei>puuof  ihe  ranks  as  the  result  of 
intemperance  or  dishonesty.  A  really  sound,  well-trained  business  man 
need  never  wait  long  for  a  fairly  good  appointment.  There  is  always 
room  for  him  somewhere.  The  severe  competition  for  places  is  amongst 
the  mediocrities.  From  the  employers'  side  it  is  always  worth  while  to 
pay  a  good  man  well.  Cheap  men  are  rarely  worth  the  outlay,  especially 
if  they  are  working  discontentedly.'' 

Men  may  have  brilliant  careers  at  universities;  they  may  be  what 
is  generally  known  as  "well-read  men,"  and  be  the  possessors  of  dis- 
tinguished degrees,  and  yet  be  unable  to  make  any  headway  in  the  cold, 
hard  struggle  for  existence;  that  is  to  say,  they  have  extraordinary  capa- 
city for  absorbing  the  writings  of  others,  but  have  no  originality.  While 
in  all  the  professions  to-day  the  possession  of  a  degree  from  a  University 
of  repute  is  very  properly  accepted  as  e\adence  of  proficiency,  still  it  does 
not  always  carry  the  special  qualifications  necessary  to  success.  Above 
all  things,  a  man  must  have  some  natural  ability.  In  no  profession,  prob- 
ably, is  this  more  noticeable  than  in  law.  As  we  look  around  us  we  see 
some  barristers  who  have  successfully  passed  examinations  but  are  not 
blessed  with  that  intuitive  ability  which  counts  for  so  much;  others  are 
able  to  add  to  their  legal  knowledge,  keen  powers  of  perception,  ready 
wit,  the  natural  facility  to  grasp  an  opportunity  the  moment  it  arises, 
and  many  other  attributes  which  contribute  to  success.  The  one  bar- 
rister conducts  his  case,  relying  almost  entirely  on  his  knowledge  of  law, 
which  he  gained  from  books  and  Acts  of  Parliament;  the  other,  in  addi- 
tion to  those  qualifications,  brings  his  personal  resourcefulness  to  bear, 
observes  the  slightest  discrepancy  which  arises  during  the  progress  of  the 
case,  snaps  it  up  and  makes  capital  out  of  it.  The  same  conditions  hold 
good  very  largely  in  our  own  profession. 

The  Australian  Journal  of  Dentistry. 
{To  be  continued) 


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A  SYSTEM  OF  DENTAL  BOOK-KEEPING  103 

A  SYSTEM  OF  DENTAL  BOOK-KEEPING 

By  F.  a.  Ross,  D.D.S.,  Gilroy,  Cal. 

My  object  in  this  article  will  be  to  outline  a  system  of  dental  book- 

^ping  which  six  years'  use  in  practice  has  demonstrated  to  be  simple, 

^  ^^omical,  complete  in  all  essentials,  and  to  require  a  minimum  of  time 

^,.  ^  effort  on  the  part  of  the  dentist.     The  system  is  not  wholly  original 

lu    ^  rne,  being  rather  an  amplification  of  a  stock  system  on  the  market  in 

^t^.  ^^-leaf  ledger  form,  from  which  I  have  evolved  the  other  details  as  I 

K      ^^1  a  requirement  for  them  in  my  practice. 

V/^^CJ^mong  the  advantages  of  this  system  are  the  following:  it  leaves 

H^^ing  to  the  memory,  even  for  an  hour;  it  enables  one  to  strike  a 

^\lce  or  check  up  his  volume  of  business  for  any  period  of  time,  a 

T^t^t,  month  or  year,  in  a  few  minutes'  time;  it  requires  only  a  few 

minutes'  time  daily,  and  an  occasional  couple  of  hours,  say  once  a  month, 

to  index  and  transfer  accounts  and  enter  new  leaves. 

The  first  item  in  the  system  consists  of  a  4  x  6  in.  sheet  of  paper, 
ruled  as  in  Fig.  i,  and  which  I  call  the  day  tag.     On  assuming  business 
for  the  day  I  slip  one  of  these  sheets  into  the  type-writer,  noting  the 
date  in  the  space  above  the  horizontal  lines.    Thereafter,  during  the  day, 
upon  dismissing  a  patient,  and  before  beginning  the  next  operation^  I  jot 
down  in  the  lower  space  the  name  of  the  patient  just  dismissed,  with  a 
note,  in  detail,  of  the  operation  performed,  together  with  the  charge 
therefore,  and  credit  any  amount  paid,  in  the  spaces  provided  by  the 
ruling  at  the  right  hand  side  of  the  sheet.    This  I  do  with  each  suc- 
ceeding case  throughout  the  day,  and  by  using  abbreviations  in  noting 
down  the  operations  I  find  that  one  line  is  usually  all  that  is  required  per 
patient,  so  that  a  sheet  is  usually  sufficient  to  record  all  operations  for 
one  day.    The  use  of  the  typewriter  of  course  makes  for  economy  of 
space.    While  its  use  is  a  refinement,  and  makes  for  neatness,  order,  and 
legibility,  it  is  not  essential.    The  notations  can  be  made  in  pencil,  and 
the  sheet  kept  on  the  cabinet  beside  the  chair  if  preferred.     I  did  it  that 
way  for  three  or  four  years  before  I  had  a  typewriter. 

Now  let  us  take  a  sample  day's  run  in  the  oflSce,  and  see  how  it  works. 
Our  first  appointment  in  the  morning  is  with  Mr.  Jones,  for  whom  we 
devitalize  the  right  upper  first  molar,  and  put  in  an  amalgam  filling  in  the 
left  upper  second  bicuspid.  We  record  it  thus:  F.  Jones,  T.  3,  N.  O.  A. 
13-  T.  stands  for  treatment;  N.  for  novocain  (denoting  that  I  used 
peridental  anaesthesia  for  pulp  removal) ;  3  denotes  the  number  of  the 
tooth  operated  upon,  as  found  on  the  i)age  in  the  ledger  devoted  to  Mr. 
Jones's  case.  Similarly,  A.  means  amalgam,  and  the  number  denotes  the 
tooth.    He  also  paid  a  deposit. 


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104  THE  DENTAL  DIGEST 

JANUARY   I,   I916 


F.  Jones,  T.  N.  3;  A.  13 

H.  Johnson  

Willie  Hooper,  sed.  Ir.  19       ... 

Mrs.  J.  Smith,  G.  9,  analg.    . 

Mr.  Willson,  scaling,  emet.  Alcresta 

Miss  Allen,  r.  c.  f.  cr.  pr.  5 

Mr.  White,  ext.  2-3,  N20       ... 

Rent,  $30 


Fig.  I.    The  Day  Tag 


4.50 

2S.CX> 

13.50 

■50 

9.00 

5  00 

5.00 

3  00 

3  50 

3SO 

$25.50 


$47.00 


Our  next  appointment  is  with  Mrs.  Smith,  for  whom  we  insert  a  gold 
filling  in  the  left  superior  central.  We  also  used  analgesia  in  the 
preparation  of  this  cavity.  Hence,  ''Mrs.  Smith,  G.  9,  analg."  But 
during  the  time  Mrs.  Smith  was  in  the  chair  Mr.  Johnson  called  and  paid 
his  account  of  $13.50.  We  put  that  on  the  tag  then  and  there.  We  are 
pretty  busy  with  that  gold  filling  in  Mrs.  Smith's  mouth,  but  that  is  all 
the  more  reason  why  we  stop  and  jot  it  down.  If  we  wait  till  after  5 
P.M.  it  may  slip  our  mind,  and  so  lay  grounds  for  future  trouble  when  we 
send  Johnson  another  statement  and  he  comes  in  and  declares  he  paid  us, 
and  we  don't  remember  it  nor  have  any  record  of  it.  Also  little  Willie 
Hooper  came  in  with  a  toothache  during  the  time  we  were  busy  with  Mrs. 
Smith's  case,  and  we  sealed  in  a  sedative  treatment  to  keep  him  com- 
fortable until  another  day  when  we  could  give  him  more  attention.  So 
we  slip  in  a  memorandum  on  our  day  tag,  and  thus  perhaps  save  our- 
selves 50c.  which  we  possibly  would  have  forgotten  to  charge  up  to  the 
account  if  we  had  waited  until  after  our  day's  work  was  done  before 
making  up  our  record  of  the  day's  transactions,  from  memory. 

Our  next  patient  is  Mr.  Willson,  a  pyorrhea  case.  We  scale  some  of 
his  teeth,  apply  emetine  solution,  and  prescribe  a  course  of  Alcresta 
tablets.     He  paid  $5  on  account. 

I  wish  to  interpolate  here  that  I  find  a  second  operating  chair  a  great 
help  in  handling  such  cases  as  Willie's,  which  come  in  during  the  progress 
of  a  long  operation.  It  minimizes  the  time  lost  by  the  interruption. 
Also,  I  wish  to  mention  another  thing  which  saves  a  great  deal  of  time 
and  lost  motion.  That  is  the  use  of  an  examination  record.  I  use  the 
Allen  examination  book,  making  a  thorough  examination  of  the  teeth  at 
the  first  sitting,  outlining  on  the  cut  of  the  teeth  given  on  each  page  the 
cavities  found,  treatments  necessary,  etc.,  also  noting  down  any  estimate 
made,  agreements  about  payment  of  account,  etc.  Then  at  all  subse- 
quent sittings  I  work  from  this  chart,  checking  off  each  piece  of  work  as 
it  is  completed  and  noting  any  changes  made  from  the  original  plan  of  the 
work.  This  saves  time  hunting  around  the  mouth  to  see  what  to  do  next, 
avoids  overlooking  concealed  cavities  which  were  found  in  the  first 


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SYSTEM  OF  DENTAL  BOOK-KEEPING 


105 


diligent  examination,  and  is  a  first  hand  memory  tickler  regarding  the 
details  of  the  case  that  one  would  not  purposely  overlook,  but  which  are 
soon  and  easily  forgotten.  Estimates  and  agreements  are  later  trans- 
ferred to  the  permanent  case  record  in  the  ledger. 


JANUARY 


1916 


January  1 
2 
3 

4 
5 
6 
8 

9 
10 
II 
12 
13 
15 
16 

17 
18 

19 
20 
22 
23 
24 
25 
26 

27 
29 
30 
31 


Rec'd 

Booked 

$37  50 

$30.00 

500 

23.00 

550 

22.00 

13  50 

19  50 

26.00 

20.00 

18.00 

11.00 

7.00 

24.00 

300 

14-50 

28.50 

20.50 

6.50 

29.50 

5.00 

1. 00 

21.50 

19  50 

43  00 

6.00 

22.00 

107.00 

43.00 

1500 

32.00 

14-50 

S-oo 

29.00 

129.00 

30.50 

8.50 

29.00 

20.50 

14  50 

5.00 

19  50 

26.00 

30.00 

67.50 

51.00 

6.50 

16.00 

14.00 

22.00 

$552.50!  $671.50 
Fig.  No.  2.    Bkiifiister  cash  and  bill  card  (pink)  for  adding  up  totals 

The  other  items  on  our  day  tag  show  that  we  filled  the  root  canals 
in  the  right  upper  first  bicuspid,  for  Miss  Allen,  and  prepared  the  tooth 
to  receive  a  crown;  also  extracted  the  right  upper  first  and  second  molars 
for  Mr.  White,  using  nitrous  oxid  oxygen  anesthesia  for  the  operation. 
He  paid  in  full. 

Thus  we  note  down  on  our  day  tag  all  the  transactions  of  the  day 
each  in  turn  and  at  the  moment,  and  at  the  close  of  the  day's  work  add  up 
the  totals  in  the  charge  and  credit  columns.  After  transferring  the 
items  on  the  day  tag  to  the  individual  records  in  the  ledger,  the  day  tags 
are  filed  in  a  drawer  in  the  desk  until  the  end  of  the  month.  Then  I  use 
a  Bannister  cash  and  bill  card  (pink)  on  which  to  add  up  the  totals  of  all 
the  day  tags  of  the  month,  thus  securing  totals  showing  all  charges  and 
receipts  for  the  month  (Fig.  2).  The  day  tags  and  the  pink  card,  I  then 
place  in  another  drawer  along  with  tags  and  cards  of  previous  months. 
At  the  end  of  the  year,  by  simply  adding  up  the  twelve  totals  shown  on 
the  pink  cards  I  have  a  summary  of  receipts  and  charges  for  the  year. 


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106 


THB  DENTAL  DIGEST 


We  now  come  to  the  case  records.  For  this  purpose  I  use  a  modifica- 
tion of  the  loose  leaf  ledger  made  by  the  Workman  Manufacturing  Com- 
pany, 1 200  W.  Monroe  St.,  Chicago.  They  call  it  their  No.  O  special. 
My  objections  to  their  original  stock  record  sheets  are  that  there  is  some 
needless  repetition  in  the  headings;  there  are  some  headings  I  do  not 
need,  and  some  not  given  that  I  do  need;  I  prefer  a  different  arrangement 
of  the  headings;  the  original  is  provided  with  case  record  ruling  on  one 
side  only.  Therefore  I  had  them  print  leaves  to  order  (Fig.  3)  which 
meet  my  requirements  very  much  better,  and  by  having  both  sides  alike 
provides  double  the  record  space  in  a  given  bulk  of  sheets.     I  had  these 


0 
=0 

IBS 

III    lllilVIV^'l'.')        ■-  V         ^TTil 

ffl^AS^M    "^  Jf9-^'d^^. 

^H'»'fJH» 

II  IIP  IN      - 

bM 

UsiLi-    a 

f'k'                                4f  a  . 

tttfi 

* 

-- 

Fig.  No.  3.     Loose  leaf  ledger 

printed  before  I  took  up  the  use  of  nitrous  oxid.  My  next  order  will 
provide  headings  to  include  analgesia  and  anesthesia.  I  now  make  a 
note  of  its  use  in  the  ** Remarks"  column. 

The  manner  of  making  up  the  case  record  is  obvious  from  illustration 
No.  3,  We  have  the  patient's  name  and  address,  together  with  a  memo- 
randum of  the  amount  of  his  contract  and  terms  of  payment.  There  is 
a  space  to  note  by  whom  he  was  referred  to  us.  We  have  entered  the 
first  item  o£  Mr.  Jones's  account,  as  taken  from  our  sample  day  tag. 
Succeeding  operations  will  be  entered  from  other  day  tags  as  the  case 
progresses. 

The  accounts  in  this  loose  leaf  ledger  are  self  indexed  by  means  of 
yellow  sheets  having  the  letters  of  the  alphabet  arranged  on  projecting 
celluloid  tabs,  and  the  account  leaves  under  each  index  sheet  are  arranged 
with  projecting  tabs  on  which  the  name  of  the  patient  is  written  so  that 
it  is  instantly  found  upon  opening  the  ledger  at  the  proper  index  sheet. 


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A  SYSTEM  OF  DENTAL  BOOK-KEEPING  107 

Thus,  to  find  the  account  of  our  first  patient,  Mr.  Jones,  we  open  our 
ledger  at  the  celluloid  tab  "J."  Without  turning  a  single  leaf,  we  see 
the  name  we  are  looking  for  on  the  projecting  tab. 

Also,  all  the  other  current  accounts  of  patients  whose  names  begin 
with  J.  are  before  us  at  a  glance. 

Accounts  are  kept  in  the  original  binder  as  long  as  active,  or  until 
paid.  About  once  a  month,  or  whenever  convenient,  paid  accounts  are 
removed  and  placed  in  another  binder,  called  the  transfer  binder.  Be- 
fore inserting  into  the  second  binder  the  projecting  tabs  are  cut  off.  A 
photographer's  print  trimmer  facilitates  this  operation,  and  gives  a 
true  edge  to  the  leaves.  The  transferred  leaves  are  paged  numerically, 
and  for  this  purpose  I  use  a  Bates  numbering  machine  for  the  sake  of 
neatness  and  legibility,  though  it  can  be  done  \/ith  pen  and  ink  if  one 
does  not  wish  to  invest  in  a  numbering  machine. 

The  name  on  each  account  that  is  thus  transferred  is  entered  on  the 
yellow  indexing  sheet  in  the  original  ledger,  together  with  its  page  num- 
ber, under  vowel  headings  which  make  it  possible  to  find  a  name  in  a 
minimum  amount  of  time.  Thus  an  account,  whether  active  or  closed, 
can  be  found  in  the  one  ledger,  and  located  in  a  few  seconds'  time. 

By  thus  transferring  closed  accounts,  the  original  binder  is  reserved 
for  active  accounts,  and  when  sending  out  statements  at  the  end  of  the 
month  it  is  not  necessary  to  search  through  a  large  volume  of  accounts 
and  weed  out  the  active  from  the  closed.  In  fact,  I  usually  run  through 
the  ledger  in  a  few  minutes  and  type  down  on  a  plain  sheet  of  paper,  in 
alphabetical  order,  all  the  accounts  requiring  statements,  and  then 
make  out  statements  from  this  list.  By  preserving  this  list,  and  at  the 
next  statement  period  adding  the  new  accounts  that  have  accumulated 
during  the  month,  I  reduce  the  task  of  statement  rendering  to  a  minimum. 

Of  course,  in  this  system,  one  could,  if  preferred,  substitute  the  card 
system  for  the  loose  leaf  ledger.  The  principal  advantage  of  the  ledger 
is  the  reduction  of  bulk.  One  transfer  binder  will  hold  a  thousand  or 
fifteen  hundred  sheets.  The  binder  posts  are  added  to  in  sections  as  the 
binder  fills  up,  and  it  is  optional  how  many  leaves  are  put  into  one  volimoie. 
The  difference  in  volume  between  1,500  sheets  and  a  similar  number  of 
cards,  with  indexes,  is  considerable. 

The  only  other  item  in  the  system  is  an  ordinary  double  ruled  cash 
book  in  which  are  entered  the  receipts  shown  on  the  day  tags,  together 
with  expense  items  as  they  occur.  On  adding  up  at  the  end  of  the  month, 
the  total  in  the  cash  book  should  tally  with  that  on  the  pink  card  in  the 
"Received"  column.  If  it  fails  to  do  so,  the  month's  Receipts  can  be 
checked  up  on  the  day  tags  and  the  error  found. 

By  having  pink  tags  ruled  to  order,  another  column  could  be  added  to 


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108  THE  DENTAL  DIGEST 

include  the  expense  account.  At  present  I  keep  this  only  in  the  cash 
book. 

At  first,  upon  reading  this  over,  it  may  seem  as  though  there  is  con- 
siderable labor  involved  in  this  method.  I  have  gone  more  or  less  into 
detail,  and  it  may  sound  complicated  in  the  telling,  but  in  actual  use  the 
amount  of  time  it  requires  is  negligible.  A  few  seconds  after  each  opera- 
tion, with  five  or  ten  minutes  at  the  end  of  the  day,  and  a  couple  of  hours 
every  month  or  so  is  all  the  time  required,  and  it  is  time  well  spent  I  be- 
lieve, considering  the  results  it  yields. 

As  a  matter  of  fact,  the  whole  thing  can  be  turned  over  to  an  office 
girl,  with  the  exception  of  the  notations  on  the  day  tags.  A  thoroughly 
trained  girl  might  even  be  entrusted  with  that  too,  but  as  office  girls  go  I 
would  prefer  to  attend  to  that  myself.  With  all  items  correctly  entered 
on  the  day  tag,  the  girl's  errors  in  entry  can  always  be  traced  and  cor- 
rected. Personally  I  prefer  to  attend  to  my  own  bookkeeping,  limiting 
the  girl's  share  in  that  to  bill  sending  and  looking  up  the  accounts  of 
people  who  call  to  settle  while  I  am  busy  at  the  chair. 

I  have  been  prompted  to  present  this  article  by  the  fact  that  several 
of  my  dentist  friends,  happening  to  see  my  system,  have  asked  me  to 
explain  it  to  them,  and  upon  my  doing  so  have  given  it  their  thorough 
endorsement,  and  have  adopted  it  in  their  own  practice.  Since  it 
appealed  so  strongly  to  those  who  have  seen  it,  it  occurred  to  me  that 
perhaps  there  might  be  others  who  would  be  glad  to  learn  of  it. 

Should  any  of  my  fellow  Digest  readers  find  any  helpful  suggestions 
in  this  article,  I  shall  be  well  repaid  for  the  effort  spent  in  its  preparation. 

First  National  Bank  Bldg. 


TWO  GOOD  PRACTICAL  HINTS 

Waxed  Silk  :  —  Purcjiase  yourself  a  ball  of  silk  twist  or  silkateen 
from  your  dry  goods  store;  place  same  in  cup  with  sufficient  beeswax 
to  cover  when  melted,  boil  thread  in  wax  for  one  minute,  remove 
your  thread  and  let  cool.  Then  you  have  a  fine  ball  of  waxed  thread 
through  and  through,  always  ready  for  your  use. 

Good  Probe: — Remove  wood  from  common  lead  pencil,  take  a 
stiff  piece  of  wire,  bend  one  end  so  as  to  make  a  handle;  on  the  other 
end  use  small  binding  wire;  fasten  the  graphite  removed  from  pencil; 
sharpen  graphite.  Then  you  have  a  probe  with  which  you  can  push 
your  melted  gold  around  without  it  adhering  to  probe. 

C.  I.  Faison,  D.D.S.,  Dallas,  Tex. 


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ESTABLISHED  METHOD  OF  TREATMENT  109 


ESTABLISHED  METHODS  OF  TREATMENTS  MUST 
BE  FOLLOWED 

.     {Wisconsin). — In  the  case  of  Allen  v.  Voje,  recently  tried  in  the 
)^^sconsin  supreme  court,  the  principle  was  laid  down  that  a  physician  or 
^  ^^tist  in  treating  a  patient  must  follow  the  established  methods  of 
<i>^  .^^tment.     A  departure  from  approved  methods  in  general  use,  if  it 
^^^      ^^^s  the  patient,  will  render  him  liable,  however  good  his  intention 
"^^^-^O^    have  been.     It  is  however,   not  necessary  that  a  physician  or 
\\       ^5t  adhere  to  ancient  methods  of  treatment.     He  must  keep  abreast 
^\ie  times.     Some  standard  by  which  to  determine  the  propriety  of 
Xx^utment  must  be  adopted;  otherwise  experiments  will  take  the  place 
of  skill,  and  the  reckless  experimentalist  the  place  of  the  educated, 
experienced  practitioner.    When  the  case  is  one  as  to  which  a  system 
^{  treatment  has  been  followed  for  a  long  time,  there  should  be  no  de- 
parture from  it,  unless  the  surgeon  who  does  it  is  prepared  to  take  the 
^sk  of  establishing  by  his  success  the  propriety  and  safety  of  his  experi- 
ment.   The  rule  protects  the  community  against  reckless  experiments 
while  it  admits  the  adoption  of  new  remedies  and  modes  of  treatment 
only  vrhen  their  benefits  have  been  demonstrated,  or  when,  from  the 
^ecessity  of  the  case,  the  surgeon  or  physician  must  be  left  to  the  exer- 
^^•se  of  his  own  skill  and  experience.     The  skilfulness  of  a  physician  in 
^^^Tiosis  and  treatment  should  be  tested  by  the  rule  of  his  own  school. 
-ft   seems  to  be  a  sound  and  reasonable  rule  and  well  established  by  the 
^-O-o Titles  that  the  treatment  of  a  physician  or  dentist  of  one  particular 
^^^-^J  is  to  be  tested  by  the  general  principles  and  practices  of  his  school 
•  ,      ^^  not  by  those  of  other  schools,  and  that  a  physician,  surgeon  or  dentist 
^^Vand  to  exercise  such  reasonable  care  and  skill  as  is  possessed  and 
Qf      ^^ised  by  physicians,  surgeons  and  dentists  generally  in  good  standing 
^j^^  ^^«  same  system  or  school  of  practice,  or  treatment  in  the  locality 
q{         ^^ommunity  of  his  practice,  having  due  regard  to  the  advanced  state 
^r»      *Ve  school  or  science  of  treatment  at  the  time  of  such  treatment. 
xq      ^^^  a  patient  selects  one  of  the  many  schools  of  treatment  and  healing 
^^^^^^rve  him,  he  thereby  accepts  and  adopts  the  kind  of  treatment 

^^^  he  is  treated,  when  questioned  in  a  court  of  justice,  should  be 
^d  by  the  evidence  of  those  who  are  trained  or  skilled  in  that  school 


v^^  ^  ^Tion  to  that  school  or  class,  and  the  care,  skill,  and  diligence  with 
^lass.     (Allen  v.  Voje,  114  Wis.,  i). 


PROFESSIONAL   CONDUCT 


{Kentucky). — Kentucky  Statutes,  providing  that  the  board  of  health 
^^y  suspend  or  revoke  a  physician's  or  dentist's  license,  (i)  for  the  pres- 

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110  THE  DENTAL  DIGEST 

entation  to  the  board  of  any  license  which  was  illegally  or  fraudulently 
obtained,  or  the  practice  of  fraud  in  passing  an  examination;  (2)  for  the 
commission  of  a  criminal  abortion,  or  conviction  of  a  felony  involving 
moral  turpitude;  (3)  for  chronic  or  persistent  inebriety,  or  addiction  to  a 
drug  habit  to  an  extent  which  disqualifies  him  to  practice  with  safety  to 
the  people;  (4)  or  for  other  grossly  unprofessional  or  dishonorable  conduct 
of  a  character  likely  to  deceive  or  defraud  the  public  is  construed  to  create 
a  definite  standard  by  which  professional  conduct  may  be  measured,  and 
is  a  valid  exercise  of  the  police  power. 

And  although  a  physician  or  dentist  may  violate  the  professional 
code  by  advertising,  his  act  will  not  constitute  a  ground  for  revoking  his 
license,  unless  his  conduct  is  dishonorable,  fraudulent,  and  involves  moral 
turpitude  within  the  contemplation  of  the  above  statute.  (Forman  v. 
State  Board  of  Health,  162  S.  W.,  796.) 

PAYMENT   OF   PROFESSIONAL   SERVICES 

(Mimtesola). — Where  defendant  requested  plaintiff,  a  dentist,  to 
render  defendant's  niece  professional  services,  who  was  a  member  of  his 
household,  her  parents  having  been  divorced  and  did  not  inform  plaintiff 
that  the  patient  was  not  his  daughter  or  that  he  did  not  expect  to  pay  for 
the  services,  he  is  chargeable  for  the  value  of  the  services  rendered  under 
an  implied  promise.     (Bigelow  v.  Hall,  152  N.  W.,  763.) 

CURATIVE   PROPERTIES   OF   MEDICINE 

(Federal). — One  may  not  be  convicted  under  the  Food  and  Drug  Act, 
merely  because  he  advocates  a  theory  of  medicine  which  at  the  time  has 
not  received  the  sanction  of  the  profession ;  but  one  guilty  of  fraud  may  not 
escape  conviction  merely  because  some  one  may  honestly  believe  in  the 
theory  which  he  fraudulently  set  forth.  In  United  States  v.  American 
Laboratories  defendant  was  prosecuted  on  the  ground  of  having  fraudu- 
lently advertised  the  curative  properties  of  certain  patent  medicines. 
The  defense  was  that  the  medicines  contained  curative  properties  as  ad- 
vertised. 

A  jury  in  the  United  States  District  Court  found  the  defendant 
guilty  of  fraud  in  advertising  its  medicines  to  contain  properties  which 
as  a  matter  of  fact  was  mere  belief  and  speculation.  The  court  held  it 
unlawful  to  advertise  any  medicine  as  a  cure  unless  known  to  be  positive 
(U.  S.  V.  American  Laboratories,  222  Fed.,  105.) 

COUNTY   NOT  LIABLE   FOR   SERVICES 

(Georgia). — Where  a  dentist,  at  the  instance  and  upon  the  request  of 
the  sheriff,  performs  a  dental  operation  upon  one  who  is  a  prisoner  in  the 


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A  REQUEST  FOR  ADVICE  111 

custody  of  such  sherifT,  an  action  cannot  be  maintained  by  the  dentist 
against  the  county  to  recover  the  value  of  such  services.  (C.  T.  Nolan 
V.  Cobb  County,  8i  S.  E.,  124.) 


A  REQUEST  FOR  ADVICE 

Editor  Dental  Digest: 

I  have  been  for  some  time  very  much  interested  in  your  articles  on 
the  business  side  of  dentistry,  and  am  sending  a  more  or  less  disconnected 
request  for  advice. 

I  have  many  hours  that  should  be  filled,  that  are  riot,  and  want  my 
practice  to  come  from  the  good  I  may  render  my  patients  by  rendering 
to  them  such  services  as  I  would  want  rendered  to  me  or  my  mother  or 
my  wife. 

For  such  honest  services  I  want  an  honest  fee. 

You  probably  know  as  well  as  I  that  many  men  with  large  practices 
render  services,  to  the  patients  who  trust  them,  that  would  not  be  passed 
in  the  school  in  which  I  received  my  dental  education,  Harvard. 

By  such  work,  to  my  mind,  the  patient  is  not  getting  the  services  to 
which  he  is  entitled  or  a  square  deal. 

The  public  is  ignorant  as  to  the  proper  care  of  the  teeth,  and  the 
results  following  the  neglect  of  such  care. 

If  I  use  printer's  ink  in  educating  them  along  those  lines,  and  to  such 
as  come  under  my  care,  as  a  result  of  such  use  of  said  ink.  render  the  best 
services  I  am  capable  of,  in  an  honest  effort  to  help  them  by  putting  their 
teeth  in  good  condition,  am  I  not  as  ethical  in  a  broad  sense,  as  the  society 
man  who  puts  into  their  mouths  such  work  as  we  all  see,  and  takes  good 
money  for  it? 

I  feel  that  fees  are  much  too  low  for  real  honest  work  and  that  may 
be  the  reason  why  we  see  so  much  work  that  is  not  what  it  should  be  and 
is  a  disgrace  to  the  profession. 

How  can  a  man  properly  cleanse  the  teeth  for  $1? 

How  can  he  treat  and  fill,  properly,  a  molar  for  $3? 

How  can  he  use  a  high  grade  alloy  like  Twentieth  Century,  carve, 
contour,  line  with  cement  and  polish  for  $1  or  $1.50? 

How  many  of  them  let  the  girl  at  the  tooth  counter  pick  out  the  teeth 
and  the  dental  laboratory  make  the  denture? 

How  many  of  them  try  to  tell  the  patient  that  the  alloy  filling  is  a 
means  of  restoring  the  teeth  to  comfort  and  usefulness  and  that  it  mav  be 


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112  THE  DENTAL  DIGEST 

much  better  for  them  than  a  gold  crown,  and  many  times  takes  as  much 
time  and  skill,  and  is  worth  money  to  them,  the  patient? 

How  many  of  them  are  telling  the  patient  that  they  are  selling  services 
and  not  fillings,  and  will  charge  as  much  or  more  for  a  so-called  silver 
filling,  if  it  takes  time,  than  for  a  small  gold  one? 

How  many  of  them  are  trying  to  get  an)^  more  for  their  services  than 
they  did  lo  or  more  years  ago?    Shouldn't  they? 

What  is  the  difference  between  a  so-called  honest  ethical  dentist  and 
an  honest  unethical  one.    I  mean  honest  with  himself  and  his  patient? 

Do  you  not  think  a  man  who  uses  printer's  ink  can  be  as  honest  with 
his  patients  as  one  who  does  not? 

We  must  live  and  if  it  is  an  honest  living  what's  the  difference? 

If  you  were  in  practice  and  it  was  necessary'  to  increase  your  produc- 
ing time,  what  would  you  do. 

Very  truly  yours, 
Massachusetts. 

Rditor  Dental  Digest*: 

Having  read  the  Digest  for  several  years,  it  has  occurred  to  me  that 
you  might  know  some  dentist  in  or  about  Boston  who  has  put  into  prac- 
tice the  ideas  expressed  in  the  Digest  in  regard  to  fees.  About  a  dozen 
of  the  dentists  in  this  county  have  formed  a  society,  and  we  have  been 
looking  around  for  someone  who  would  be  willing  to  give  us  a  talk  on 
those  lines.  If  you  could  suggest  anyone  whom  we  might  get  in  touch 
with,  it  will  be  much  appreciated.  I  wish  to  congratulate  you  on  the 
work  the  Digest  is  doing  in  this  direction.  I  believe  it  has  done  more 
for  the  advancement  of  dentistry  than  all  the  other  journals  combined. 

Sincerely  yours, 

Boston. 

CAN  ANYONE  GIVE  INFORMATION? 

Editor  Dental  Digest: 

I  am  one  of  the  satisfied  Digest  family. 

I  wish  you  to  let  us  have  some  information  on  how  to  choose  a  dental 
location.  You  have  told  us  how  to  increase  fees  and  save  time,  but  in 
looking  for  a  location,  I  want  to  know  just  how  to  go  at  it.  Points  to 
take  into  consideration,  etc. 

Yours  very  truly, 

Washington. 

*  If  our  readers  know  of  anyone  who  has  put  into  effect  the  business  building  suggestions 
of  The  Dental  Digest  the  editor  will  be  glad  to  have  him  address  "  Boston,"  care  of  The  Dental 
Digest,  220  W.  4 2d  St.,  New  York. 


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[This  department  is  in  charge  of  Dr. 
V.  C.  Smedley,  604  California  Bldg., 
Denver,  Colo.  To  avoid  unnecessary  de- 
lay, Hints,  Questions,  and  Answers  should 
be  sent  direct  to  him,]* 

A  Painless  Way  to  Open  a  Sore  Tooth. — In  opening  up  a  very  sore 
tooth  when  the  patient  cannot  stand  the  pressure  of  the  bur,  I  find  the 
following  method  very  good.  Take  your  dentimeter  and  make  a  wire 
loop  as  if  taking  a  measurement  for  a  crown.  Then  let  your  assistant 
pull  on  the  dentimeter  while  you  open  up  the  tooth.  Or  better  yet,  let 
the  patient  help  you  by  holding  dentimeter,  then  if  it  hurts  they  will 
equalize  the  pressure  by  pulling  a  little  harder. — James  J.  Jones,  D.D.S., 
Scottsbluff,  Nebr. 

To  Repair  a  Hole  in  a  Bicuspid  or  Molar  Crown. — Take  a  clean 
piece  of  asbestos  paper  and  cut  out  a  disc  that  will  fit  inside  the  band. 
Place  occlusal  surface  on  something  flat  and  press  the  disc  down  firmly 
and  evenly.  Moisten  several  pieces  of  asbestos  and  fill  up  the  crown. 
Place  on  a  charcoal  block  and  turn  on  the  flame  of  the  blowpipe.  Cut  a 
piece  of  solder  large  enough  to  cover  the  hole  and  place  it  in  position.  Flux 
well  and  turn  on  the  heat.  When  the  solder  starts  to  curl  on  the  edge, 
turn  it  down  with  a  pointed  slate  pencil,  and  keep  applying  the  heat  until 
the  solder  is  caught  all  around.  With  a  little  practice,  you  can  drag 
solder  around  almost  any  place  with  an  ordinary  slate  pencil.  If  the 
crown  is  on  a  bridge,  wrap  the  bridge  with  asbestos  paper,  wiring  it  on, 
and  proceed  as  above. 

An  Ordinary  Hail  Screen. — If  you  are  afraid  that  your  investment 
will  crack  and  pull  away  when  soldering  a  big  bridge,  invest  the  bridge 
on  a  piece  of  hail  screen  cut  to  suit  the  case.  A  piece  of  hail  screen  also 
makes  a  very  handy  thing  to  place  over  the  spider  of  your  gas  or  gasolene 
stove  on  which  to  place  an  investment  of  any  kind. — Harry  M.  Tweedy, 
D.D.S.,  Smith  Centre,  Kansas. 

To  Tighten  Old  Plates. — If  you  want  to  delight  the  next  patient 
for  whom  you  repair  an  upper  plate,  just  previous  to  investing,  flow  a 
rounded  **bead"  or  ridge  of  wax  just  inside  the  border  clear  around  the 
periphery  of  the  plate. 

*ln  order  to  make  this  department  as  live,  entertaining  and  helpful  as  possible,  question? 
and  answers,  as  well  as  hints  of  a  practical  nature,  are  solicited. 


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114  THE  DENTAL  DIGEST 

Did  you  ever  notice  blisters  on  the  plate  where  a  bubble  was,  in  repair 
jobs?  Well,  that  is  what  happens  in  this  case.  The  wax  bums  out  and 
the  rubber  expands  there. — ^J.  F.  Adams,  D.D.S.,  Clinton,  Ind. 

To  Remove  an  Inlay  Model  from  a  Difficult  Cavity. — ^Hold  the 
end  of  a  piece  of  number  40  copper  wire  in  the  flame  of  an  alcohol  lamp 
until  a  globule  of  metal  is  melted  on  it.  Seize  the  wire  about  a  sixteenth  of 
an  inch  from  the  end  with  a  pair  of  dressing  pliers.  Heat  the  pliers  until 
the  globule  is  hot,  place  it  against  the  wax  model  permitting  the  metal  to 
melt  into  the  wax,  and  cool  it.  Force  applied  to  the  wire  now  will  cause 
the  wax  model  to  leave  the  cavity  along  the  lines  of  least  resistance.  The 
wire  may  now  be  cut  close  to  the  wax  and  the  sprue  attached. — F.  H. 
Miller,  D.D.S.,  Aylmer,  Ont. 

[I  would  suggest  the  substitution  of  gold  for  the  copper  wire  here,  as 
the  globule  of  copper  would  mar  your  finished  inlay,  if  it  happened  to  be 
cast  into  an  exposed  portion  of  same. — V.  C.  S.] 

When  Glower  Burns  out  in  the  Dentiscope  Lamp. — ^To  avoid 
delay  and  inconvenience  while  waiting  for  a  new  burner  from  supply 
house,  remove  lighting  device  from  the  ground  glass  shade  and  turn  on  the 
current;  when  the  heater  is  at  the  maximum  temperature  touch  the 
broken  glower  together  and  it  will  fuse  at  the  break;  have  used  one  glower 
over  a  year  that  has  broken  several  times. — George  E.  Cox,  D.D.S., 
Wilmington,  Delaware. 

A  Method  for  the  Correct  Application  of  Davis  Crowns  to 
Roots. — To  prevent  failures  due  to  displacement  of  crown  and  weakening 
of  cement  during  process  of  cementation,  caused  by  movement  when 
holding  crown  with  fingers.  After  the  root  is  treated  and  filled,  grind 
root  as  usual,  apply  post  to  root,  having  collar  on  post  flush  with  surface 
of  root,  apply  crown  and  grind  wh«re  necessary,  and  after  obtaining  the 
conditions  necessary  for  an  ideal  substitute  of  the  missing  tooth,  cement 
the  post  in  the  root.  Then  attach  the  crown  to  post  and  root  with  gutta- 
percha, obtaining  correct  alignment  of  crown  before  hardening  of  gutta- 
percha. If  opposing  tooth  strikes  the  crown,  grind  at  this  point.  (If 
crown  becomes  loosened  during  grinding  re-attach  with  gutta-percha.) 
After  hardening  of  gutta-percha  and  conditions  are  ideal,  take  impression 
(not  bite)  of  crown  and  adjacent  teeth  with  modelling  compound,  chill 
and  remove.  Remove  crown  and  all  gutta-percha,  dry  with  chloroform 
and  hot  air.  Apply  crown  to  root  with  cement,  place  impression  over 
crown  and  apply  steady  pressure,  until  cement  has  hardened.  Remove 
impression  and  trim  away  aft  excess  of  cemeftit.  If  the  technic  is  still 
fully  performed  and  all  moisture  excluded  you  will  get  results  impossible 
with  the  old  method  of  holding  with  the  fingers.    This  method  consumes 


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QUESTIONS  AND  ANSWERS  115 

more  time  but  it  pays  in  the  end. — Monreith  Hollway,  D.D.S.,  Buffalo, 

N.Y. 

Extracting  a  Post  from  a  Frail  Root. — In  extracting  a  post 
from  a  frail  root  with  a  post  puller  there  is  always  danger  of  splitting 
the  root.  The  likelihood  of  this  happening  may  be  reduced  to  the 
minimimi  by  taking  a  piece  of  twenty-eight  gauge  German  silver  plate, 
cut  a  hole  through  it  large  enough  to  pass  over  the  post  and  trim  into 
a  disk  about  the  size  of  the  root  face.  This  disk  may  then  be  placed 
on  the  root  with  post  projecting  through  its  center.  The  post  puller 
may  then  be  placed  in  position  and  as  it  is  tightened  the  part  of  the 
instrument  which  is  intended  to  bear  on  the  root  rests  against  the  metal 
disk  and  does  not  slip  or  spread  and  the  post  may  be  drawn  with  safety. 
If  the  face  of  the  root  is  uneven  from  decay,  a  bit  of  base-plate  gutta 
percha  may  be  molded  into  the  cavity,  the  disk  pressed  into  place  and 
chilled  with  cold  water,  giving  an  even  base  for  the  instrument  to  press 
against. — ^J.  A.  Bullard,  D.D.S.,  Chicago,  111.  —The  Denial  Review, 


QUESTIONS  AND  ANSWERS 

Question  No.  i. — ^What  metal  is  best  for  castings,  to  be  used  under 
gold  crowns,  for  the  purpose  of  building  up  badly  decayed  roots  to  support 
crowns?  Would  there  be  danger  in  using  coin  silver,  containing  ten  per 
cent,  copper,  in  case  the  crown  failed  and  exposed  the  coin  silver  to  the 
secretions  of  the  mouth? 

Question  No.  2. — Would  like  the  name  and  address  of  an  insurance 
company,  that  insures  dentists  against  malpractice  suits.  I  believe  every 
dentist  should  carry  such  insurance,  when  our  doctors  are  blaming  crowns, 
and  bridges,  whether  they  are  sanitary  or  not,  for  case  after  case  of  sys- 
temic disease. — G.  W. 

Answer  No.  i. — I  see  no  serious  objection  to  the  use  of  coin  silver  for 
the  purp)ose  you  suggest,  though  I  cannot  speak  from  experience  with  it. 
I  do,  however,  use  pure  silver  for  this  purpose  and  find  it  entirely  satis- 
factory. 

Answer  No.  2. — I  am  told  by  an  insurance  man  here  that  any  of  the 
companies  carrying  protective  policies  for  physicians  and  surgeons  insure 
dentists  on  the  same  basis.  There  are  probably  other  companies  doing 
the  same  thing,  but  he  gives  me  the  names  of  these:  Fidelity  &  Casualty 
Co.,  and  Maryland  Casualty  Co.  Rate  $15  per  thousand.  Limit 
$5,000  for  one  suit  and  limit  $15,000  for  one  year, — V.  C.  S. 

Question. — Will  you  please  give  me  a  simple  method  of  employing  the 
aqua  regia-ferric  process  of  separating  gold  or  gold  alloy  from  platinum.-— 
C.  B.  K. 


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116  THE  DENTAL  DIGEST 

Answer. — ^Answering  your  question  on  how  to  separate  platinum 
from  gold  alloy.  First  add  silver  to  reduce  alloy  to  6k.  Dissolve  silver 
and  copper  with  nitric  acid  and  wash  residue  thoroughly  in  water.  Dis- 
solve residue,  which  should  now  be  pure  gold  and  platinum,  in  aqua  regia 
(one  part  hydrochloric  and  two  parts  nitric  acid).  Precipitate  gold  with 
sulphate  of  iron.  Filter  and  wash.  Precipitate  platinum  with  solution 
of  ammoniae.  Filter  and  heat  in  crucible  to  white  heat,  just  burning 
filter  paper  out.  This  when  cool  gives  you  sponge  platinum  which  had 
best  be  sent  to  a  platinum  refiner  to  melt  and  roll. — V.  C.  S. 

Answer. — In  Practical  Hints,  November  issue  of  the  Dental  Di- 
gest, Dr.  M.  M.  Brown,  of  Macon,  Miss.,  under  hint  number  three, 
refers  to  the  use  of  a  sheet  of  bibulous  paper  for  squeezing  out  the  excess 
of  mercury  from  amalgam.  A  better  way  still  is  not  to  have  any  excess 
mercury  in  the  amalgam.  Secure  a  little  mortar  and  pestle,  first  pour 
the  desired  amount  of  mercury  in  the  mortar,  then  a  little  alloy,  and  mix 
in;  then  continue  to  add  alloy  until  all  mercury  is  mixed  in  to  a  firm  mass; 
take  amalgam  from  mortar  with  fingers  to  a  piece  of  rubber  dam,  in  this 
rub  rapidly  in  palm  of  hand  in  order  to  evenly  unite  all  particles  of  alloy 
and  mercury.  In  this  way  you  have  a  perfect  mixture  and  a  clean  filling 
material. — M.  L.  Brockington,  Florence,  So.  Car. 

Answer. — In  the  November  issue  of  the  Dental  Digest  I  find  a 
recommendation  of  atomized  alcohol  for  cleaning  the  synthetic  slab  and 
eyeglasses.  I  have  found  another  excellent  use  for  this  alcohol,  namely 
cleaning  mouth  mirrors  which  have  become  dirty  in  any  way  from  use  in 
the  mouth.  While  I  am  working  for  the  same  patient  I  do  not  claim  to 
sterilize  my  mirrors  by  this  method.  The  alcohol  when  wiped  off  takes 
whatever  dirt  there  was  with  it,  and  leaves  the  mirror  clean  and  clear 
which  is  a  great  aid  to  one  who  works  almost  entirely  with  the  mirror. — 
Horatio  C.  Meriam,  D.M.D.,  Salem,  Mass. 

Answer. — In  the  last  issue  of  the  Digest  I  read  about  coating  strips 
and  discs  with  soap  to  facilitate  polishing  hy  doing  away  with  unneces- 
sary friction  and  to  also  aid  in  recovering  the  otherwise  wasted  gold. 
Would  say  that  I  have  long  been  using  cocoa  butter  for  this  purpose  and 
believe  it  better.  It  is  put  up  in  handy  form  and  less  objectionable  to  the 
patient.  Also  instead  of  coating  engine  belt  with  beeswax  and  resin  to 
make  it  hold  tightly,  try  slipping  a  small  rubber  band  into  the  pulley 
groove  on  both  engine  and  handpiece.  It  will  work.  You  can  run  the 
belt  more  loosely  thereby  prolonging  its  life  and  saving  wear  on  all  bear- 
ings concerned.  The  belt  dressing  previously  mentioned  doubtless  would 
dirty  the  belt  and  leave  a  bad  streak  on  your  white  coat  should  the  belt 
chance  to  rub  the  latter  as  is  often  the  case.— F.  W.  M. 


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AN  EPITOME  OP  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    117 


AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL 
LITERATURE 

[The  Dental  Review^  January,  1916] 

Contents 

Original  Communications 

*The  Dental  Pulp  and  Periapical  Tissue:  Diagnosb  and  Prognosis  of  Their  More  Common 
Pathologic  Conditions.    By  William  H.  G.  Logan. 

The  Business  Side  of  Dentistry.     By  Guy  F.  Corley. 

Root  Canal  Preparation.    By  J.  R.  Callahan. 

Why  Some  Fillings  Fail.    By  R.  Rodgers. 
•Extraction  of  Teeth  as  a  Surgical  Operation.    By  E.  L.  Teskey. 

Proceedings  of  Societies 

Illinois  State  Dental  Society,  Fifty-first  Annual  Meeting  Held  at  Peoria,  May  11-14,  191 5. 
Wisconsin  State  Dental  Society,  Forty-fifth  Annual  Meeting  Held  at  Oconomowoc,  July 

Chicago  Dental  Society. 


Editorial 


The  Best  Year  Yet. 
Practical  Hints  Memoranda. 


THE  DENTAL  PULP  AND  PERIAPICAL  TISSUES:    DIAGNOSIS  AND  PROGNOSIS 
OF  THEIR  MORE  COMMON  PATHOLOGIC  CONDITIONS 

By  William  H.  G.  Logan,  M.D.,  D.D.S.,  Chicago,  III. 

Cardinal  symptoms  and  findings  accompanying  that  contraindicate 
the  efort  to  save  the  pulp's  vitality  when  the  root  ends  are  fully  formed, 

A. — ^All  pulps  exposed  by  dental  caries  should  be  considered  infected, 
therefore  removal  in  every  instance  is  indicated.  B. — When  a  pulp  has 
been  exposed  by  accident  and  the  tissue  injured,  for  example,  by  exca- 
vator or  bur,  the  vitality  of  the  pulp  cannot  be  permanently  maintained. 
C. — Remove  the  dental  pulp  in  those  cases  where  carious  dentin  is  found 
lying  in  contact  with  it.  D. — When  the  paroxysms  of  pain  have  been  of 
one  or  two  hours'  duration  or  have  become  constant  and  occur  with  or 
without  the  application  of  a  known  irritant  and  are  most  pronounced  at 
night,  the  prognosis  of  this  pulp's  vitality  is  hopeless.  E. — When  a  tooth 
becomes  sore  under  pressure  as  result  of  a  periapical  inflammation  caused 
by  the  pulp  disease  spreading  by  continuity  to  the  tissues  beyond  the  root 
end,  begin  treatment  that  is  to  terminate  in  the  filling  of  the  root  canal. 
F. — Every  pulp  should  be  removed  when  the  pain  is  momentarily  re- 
lieved by  the  application  of  cold  water. 

In  the  application  of  the  above  statement,  let  it  be  remembered  they 


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118  THB  DENTAL  DIGEST 

only  have  reference  to  pulp  diseases  in  teeth  that  have  reached  full 
development. 

Pulp  capping  with  our  present  technic  should  be  looked  upon  as  a 
doubtful  procedure  in  all  cases  after  the  root  end  has  formed.  I  believe 
to  cap  a  pulp  that  has  been  exposed  by  either  dental  caries  or  from  the 
removal  of  carious  dentin  that  was  lying  in  contact  with  the  pulp  is  to 
court  positive  failure.  However,  many  careful  operators  have  suc- 
cessfully capped  pulps  before  the  root  end  had  fully  formed,  that  were 
exposed  in  the  process  of  cavity  preparation  by  opening  through  a  thin 
layer  of  normal  dentin.  I  believe  there  is  an  agreement  that  it  is  wise 
in  many  instances  to  cap  pulps  for  the  purpose  of  maintaining  the  pulp's 
vitality  as  long  as  possible,  when  we  wish  the  benefit  of  the  activity  of 
the  odontoblastic  cells  to  complete  root  end  development. 

EXTRACTIONS  OF  TEETH  AS  A  SURGICAL  OPERATION 
By  E.  L.  Teskey,  Shabonna,  III. 

Impress  on  the  patient  that  the  extraction  of  a  tooth  is  no  simple 
operation,  that  it  requires  skill  and  care  and  that  the  result  may  be  serious 
if  not  properly  performed;  then  quiet  the  pain,  put  the  tooth  at  ease, 
give  a  cathartic  and  send  him  home  until  the  next  day.  On  his  return 
proceed  to  prepare  the  mouth  by  cleaning  all  the  teeth,  washing  out  the 
nose  and  throat,  rendering  the  field  as  aseptic  as  possible.  That  this 
cannot  be  complete  is  no  reason  that  it  should  not  be  attempted.  Have 
all  instruments  and  hands  sterilized  as  carefully  as  for  a  major  operation; 
now  proceed  as  the  case  indicates,  using  a  general  or  local  anesthetic  as 
desired.  Be  sure  that  there  will  be  no  pain  and  that  you  will  have  plenty 
of  time  to  do  the  work  thoroughly.  Remove  all  of  the  tooth,  using  no 
more  force  than  is  needed,  and  if  it  is  necessary  to  lacerate  the  gum, 
dissect  it  out  of  the  way,  so  that  there  will  be  no  contusion  of  the  soft 
tissue.  Carefully  wash  out  the  wound  with  sterile  water  and  replace  the 
gum  tissue  in  normal  position;  dismissing  the  patient  for  the  day.  The 
patient  should  be  fed  with  soft  food  until  the  wound  is  healed.  The 
dentist  should  see  the  case  every  day  until  there  is  no  danger  of  a  second- 
ary infection. 

I  know  you  will  say  that  the  patient  will  object  to  the  trouble  and  be 
unwilling  to  pay  for  it,  but  I  believe  that  when  the  patient  understands 
the  seriousness  and  importance  of  the  operation  these  would  be  second- 
ary considerations.     In  the  meantime  work  toward  this  end. 

Within  my  memory  the  public  went  to  the  jewelers  an  1  traveling 
peddlers  for  their  glasses,  but  now  the  oculist  has  no  trouble  in  getting 
good  fees  for  his  services  and  the  patient  is  satisfied.  The  first  thing  is 
to  realize  the  seriousness  of  the  operation  ourselves  and  then  educate 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     119 

the  public.     This  is  an  age  of  education;  the  people  are  awaiting  the 
teachers;  it  is  up  to  you. 

In  conclusion  I  can  see  it  in  no  other  light  than  that  the  general 
surgeon  is  either  a  charlatan  and  working  for  effect,  or  the  dentist  is 
careless  and  not  giving  the  people  the  best  that  is  in  him. 

[The  Dental  Cosmos^  January,  1916] 

Original  Communications 

♦Mandibular  Anesthesia.    By  Theodor  Blum,  D.D.S.,  M.  D. 
The  Application  of  Local  Anesthesia  to  Dentistry.    By  Leo  Stern,  D.D.?. 
Indications  for  and  Construction  of  Fixed  or  Removable  Bridge  Work.    By  Thomas  P. 

Hinman,  D.D.S. 
The  Importance  of  Biology  as  Applied  to  Dentistr>'.    By  Dr.  Ch.  F.  L.  Nord. 
The  Germicidal  Efficiency  of  Some  Copper  Cements  Used  in  Dental  Work.    By  R.  F. 

Bacon,  Ph.  D. 
A  Contribution  to  the  Study  of  Faces.    By  L.  G.  Singleton,  D.D.S. 
*The  Irrationality  of  Bacterial  Vaccines  in  the  Treatment  of  Pyorrhea  Alveolaris.   By  A.  H. 

Merritt,  D.D.S. 
Practical  Value  of  Mouth  Hygiene.    By  H.  W.  Wiley,  M.D. 


Correspondence 


A  Rejoinder  by  Dr.  Rhein. 
"Square  Deal"  Examinations. 


Proceedings  of  Societies 

Pennsylvania  State  Dental  Society. 
Susquehanna  Dental  Association  of  Pennsylvania. 

Editorial  Department 

Retrogressive  Reform. 

Legal  Protection  of  the  Examinee. 

Bibliographical. 

Review  of  Current  Dental  Literature. 

Periscope. 

Hints,  Queries,  and  Comments. 

MANDIBULAR  ANESTHESIA 

By  Theodor  Blum,  D.D.S.,  M.D.,  New  York 
Oral  Surgeon  and  Dental  R'dnigenologist,  New  York  Post  Graduate  Medical  School  and  Hospital 

writer's  TECHNIC 

I  will  now  describe  the  technic  of  mandibular  anesthesia  which  I 
am  accustomed  to  teach.  It  is  similar  to  SeidePs  method,  modified  only 
by  using  the  index  finger  of  the  left  hand  for  palpation  and  the  right 
hand  for  injecting  on  the  right  side,  and  vice  versa;  the  bevel  of  the  heavy 
steel  needle  is  turned  toward  the  nerves  and  away  from  the  bone. 


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120  THE  DENTAL  DIGEST 

Let  us  say,  for  example,  that  we  wish  to  give  a  mandibular  injection 
on  the  right  side.  The  patient  is  requested  to  open  his  mouth,  and  with 
the  index  finger  of  the  left  hand,  the  external  oblique  line  is  found.  Now 
the  ball  of  the  same  finger  is  placed  over  the  retro-molar  triangle  in  such 
a  manner  that  the  fingernail  touches  the  internal  oblique  line;  this 
finger  is  moved  slightly  laterally  to  free  the  internal  oblique  line — ^iii 
which  position  the  finger  remains  throughout  the  injection — ^and  the 
area  is  painted  with  iodin;  the  syringe, is  grasped  with  the  right  hand, 
like  a  pen,  and  the  needle  is  run  i  cm.  above  the  occlusal  plane  of  the 
lower  jaw  through  the  soft  tissues  directly  to  the  internal  oblique  line; 
the  needle  is  retracted  somewhat,  so  as  to  release  it  from  the  periosteum, 
and  moved — the  syringe  is  in  nearly  sagittal  direction — mesiaUy  until 
one  finds  no  more  resistance  to  proceeding  backward,  i,  e,  when,  after 
passing  the  internal  oblique  line,  one  arrives  at  the  mesial  aspect  of  the 
ascending  ramus.  About  five  drops  (0.3  cc.)  of  the  solution  are  injected, 
to  anesthetize  the  lingual  nerve.  The  point  of  the  needle  is  placed  in 
contact  with  the  mesial  aspect  of  the  ascending  ramus  by  turning  the 
syringe  to  the  opposite  side,  and  remains  so  while  going  backward  a  little 
over  2  cm.,  all  told.  The  point  of  the  needle  is  now  in  the  upper  half 
of  the  mandibular  sulcus,  where  we  inject  the  remainder  of  the  solution 
(1.5  cc). 

To  anesthetize  the  left  side,  the  right  hand  is  used  as  a  guide,  and  the 
syringe  is  held  with  the  left.  A  little  practice  will  overcome  the  difficulty 
of  working  with  the  left  hand. 

In  a  few  minutes,  upon  questioning,  the  patient  will  state  that  his  lip 
and  tongue  feel  numb — ''swollen,  hot,  cold,  empty,  like  electricity,  with- 
out feeling,"  etc.  In  almost  every  case  the  molars,  bicuspids,  and  the 
cuspids  are  completely  anesthetized  in  from  ten  to  twenty  minutes. 
Before  starting  to  operate,  the  mucous  membrane  is  tested  by  compressing 
the  gingiva  with  a  pair  of  pliers  on  the  buccal  side  of  the  cuspid  and  the 
tooth  one  wishes  to  work  upon,  and  lingually.  If,  after  twenty  minutes, 
pain  is  felt  in  the  cuspid  region,  a  second  mandibular  injection  must  be 
given.  In  case  the  buccal  mucous  membrane  in  the  molar  and  bicuspid 
region  only  is  sensitive,  i,  e.  if  supplied  by  the  long  buccal  nerve,  this 
part  must  be  desensitized  with  a  horizontal  injection  in  the  apical  region 
of  these  teeth.  In  infected  cases  conductive  anesthesia  of  the  long 
buccal  nerve  may  be  resorted  to,  injecting  beneath  the  mucous  mem- 
brane of  the  cheek  below  Steno's  duct  (Williger). 

The  anastomoses  of  the  inferior  dental,  lingual,  and  mental  nerves 
explain  why  the  middle  portion  of  the  lower  jaw  with  the  incisor  teeth 
is  not  anesthetized.  To  obtain  complete  anesthesia  of  half  of  the  lower 
jaw  the  mental  foramen  of  the  opposite  side  must  be  injected — ^also 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     121 

lingually  at  the  median  line.    I  have  found  mandibular  anesthesia  to 
last  over  two  hours. 

THE  IRRATIONALITY  OF  BACTERIAL  VACCINES  IN  THE  TREATMENT  OF 

PYORRHEA  ALVEOLARIS 

By  Arthur  H.  Merritt,  D.D.S.,  New  York,  N.  Y. 
The  author  of  this  able  article  sums  up  his  conclusions  as  follows. 

CONCLUSIONS 

The  irrationality  of  the  use  of  bacterial  vaccines  in  the  treatment  of 
pyorrheji  is  proved : — 

(i)  The  exceeding  complexity  of  the  bacterial  flora  of  pyorrhea 
alveolaris,  of  which  comparatively  little  is  known. 

(2)  The  absolute  lack  of  evidence  that  any  of  the  organisms  present 
sustain  a  causal  relation  to  the  disease. 

(3)  The  imreasonableness  of  expecting  a  vaccine  to  affect  favorably 
a  disease  when  the  organisms  associated  with  it  are  practically  beyond  the 
influence  of  the  antibodies  contained  in  the  blood  and  lymph,  as  they 
are  in  pyorrheal  pockets. 

(4)  The  impossibility,  with  our  present  cultural  methods  and  limited 
knowledge,  of  preparing  a  vaccine  which  would  be  at  all  representative 
of  the  bacteriology  of  the  disease. 

(5)  The  evidence  already  at  hand  which  indicates  that  there  is  no 
qualitative  difference  between  the  bacteriology  of  pyorrhea  and  that  of 
the  normal  mouth,  and  that  the  difference  noted  is  a  quantitative  one 
only. 

(6)  The  probability  that  the  infection  in  pyorrhea  is  purely  second- 
ary. 

(7)  The  absence  of  any  proof  that  pyorrhea  which  has  not  yielded 
to  local  treatment  can  be  cured  by  vaccines,  or  that  their  use  will  prevent 
recurrence. 

(8)  The  inadvisability  of  resorting  to  a  complicated  and  uncertain 
form  of  treatment  when  simpler  and  more  efficient  methods  are  avail- 
able. 

(9)  The  fact  that  pyorrhea  "can  be  cured  by  instrumentation,  pro- 
viding only  that  it  be  skilfully  done. 

When  dentists  realize  that  pyorrhea  is  a  preventable  disease;  that, 
in  its  early  stages,  it  is  easily  and  permanently  cured;  that  only  those 
cases  are  hopeless  that  are  long  neglected;  that  no  drug  or  vaccine  ever 
will,  of  itself,  cure  the  disease,  and  that  dependence  must  be  placed  upon 
local  treatment,  they  will  have  taken  the  first  step  toward  eliminating, 
from  the  mouths  of  their  patients,  the  chief  of  mouth  infections. 


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122  THE  DENTAL  DIGEST 

[Dental  Items  of  Interest,  January,  1916] 
Contents 
Exclusive  Contributions 

The  Compressed-Air  Obtunder.    By  Raymond  E.  Ingalls,  D.D.S. 

Prosthodontia 

Technique  for  a  Simple  Bridge,    By  Herman  £.  S.  Chayes,  D.D.S. 

Orthodontia 

Report  of  Cases  Given  Before  the  Annual  Meeting  of  American  Society  of  Orthodpntists  at 

Toronto,  Ontario.    By  W.  G.  Barr,  D.D.S. 
Reports  of  Clinics  Before  the  American  Society  of  Orthodontists  at  Toronto,  July,  1914. 
Demonstration.    By  Victor  Hugo  Jackson,  M.A.,  M.D.,  D.D.S. 

Society  Papers 

Some  Suggestions  in  Securing  Adequate  and  Uniform  Dental  Legislation.    By  Homer  C. 

Brown,  D.D.S. 
The  Mission  of  the  International  Dental  Federation.    By  N.  S.  Jenkins,  D.D.S. 
Some  Refractories  Used  in  Dentistry.    Guy  Stillman  Millberry,  D.D.S. 
The  Educational  Value  of  Oral  Hygiene  in  the  Army.    Edwin  Payne  Tignor,  M.D.,  D.D.S. 
The  Importance  of  Mouth  Hygiene  During  Infancy  and  Early  Childhood.    By  Horace  L. 

Howe,  D.D.S.,  D.M.D. 

[The  Dental  Summary,  December,  1915] 

Contents 

*Precanccrous  Conditions  of  the  Face  and  Mouth.    By  John  W.  Means. 
Porcelain-faced  Molar  Crown.    By  R.  J.  Rinehart. 
Inlays,  Gold  and  Synthetic  Cement  Restoration.    By  S.  F.  Jocobi. 
The  Care  of  the  Deciduous  Teeth.    By  I.  W.  Copeland. 
The  Business  Side  of  Dentistry.    By  W.  A.  Meis. 
Modelling  Compound-Plaster  Impressions.    By  T.  D.  Dow. 
Prevention  and  Reproduction.    By  William  Conrad. 
Conductive  Anesthesia.    By  George  T.  Gregg. 
Wanted — Better  Dentists.    By  Frederic  R.  Henshaw. 
President's  Address.    By  A.  W.  McCullough. 
Prohibitive  Dentistry.    By  Edwin  S.  Hulley. 

Editorial 
Old  Time  Dentists. 

PRECANCEROUS  CONDITIONS  OF  THE  FACE  AND  MOUTH 
By  John  W.  Means,  D.D.S.,  M.D.,  Columbus,  Omo 

First:    Most  cancers  of  the  face  and  oral  region  have  in  the  be- 
ginning passed  through  a  benign  stage  which  is  termed  precancerous. 
Second:    One  of  the  most  significant  things  in  the  study  of  cancer  is 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    123 

the  fact  that  the  cells  making  up  this  growth  in  no  way  differ  from  the 
young  cells  which  are  normally  elaborated  to  repair  any  defect. 

Third:  There  are  certain  conditions  which  are  commonly  benign 
but  which  are  very  prone  to  become  malignant. 

Fourth:  We  cannot  tell  which  one  will  become  cancer  and  which 
will  remain  benign;  nor  can  we  tell  the  time  at  which  the  change  has 
occurred. 

Fifth:  One  hundred  per  cent,  cures  result  from  removal  in  the  pre- 
cancerous and  even  the  early  cancerous  stage  and  a  rapid  decrease  in  this 
percentage  follows  procrastination. 

Sixth:  Removal  by  surgical  means  is  by  far  the  safest  method  and 
is  practically  without  disfigurement  or  inconvenience. 

In  conclusion,  then,  let  me  emphasize  the  thought  that  the  responsi- 
bility of  the  dentist  is  greater  than  that  of  the  physician  in  that 
his  work  brings  him  in  more  frequent  contact  with  the  lesions  of  the  oral 
cavity. 

[The  Dental  Summary,  January,  1916] 
Contents 

The  Shoulder  Crown.    By  George  S.  Hershey. 
Gold  Inlays  as  Bridge  Abutments.    By  H.  U.  Shepherd. 
Malplaced  and  Impacted  Third  Molars.    By  L.  G.  Noel. 
Root  Canal  Filling.    By  H.  L.  Werts. 

Cast  Base  Dowel  Crowns  vs.  Ground  Joint  and  Shell  Crowns.    By  J.  A.  Gardner. 
Porcelain- Jacket  Crown.    By  George  T.  Gregg. 
A  Plea  for  More  Efficiency  and  Better  Fees.    By  Charles  A.  Tavel. 
A  Sane  System  of  Keeping  Burs.    By  R.  C.  Simmons. 
Crown  and  Bridge  Work.    By  W.  O.  Hulick. 
Advice  to  Those  About  to  Wear  Artificial  Teeth.    By  D.  W.  Barker. 
Mouth  Infection  as  a  Source  of  Systemic  Disease.    By  Frank  B.  Walker. 
The  Sterilization  of  Dental  Instruments.    By  H.  £.  Hasseltine. 
Distilling  Apparatus.    By  M.  M.  Brown. 
*A  Cleft  Palate  Case.    By  G.  B.  Speer. 
Mandibular  Conductive  Anesthesia.    By  H.  F.  Koontz. 
Report  of  Committee  on  Dental  Literature.    By  A.  C.  Barclay,  T.  A.  Hogan,  and  J.  D. 

Whiteman. 
Dentistry,  in  its  Progress  Through  the  Century,  to  Stomatology  as  a  Science.    By  James 

Truman. 
A  Loose  Pin  Banded  Crown  for  Upper  Lateral  Incisors.    By  B.  A.  Wright. 
A  Great  National  Movement.    By  W.  G.  Ebersole. 
Some  Reminiscences.    By  W.  J.  Burger. 
Prophylaxis.    By  Franklin  B.  Roberts. 

Editorial 

The  Recent  Meeting  of  the  Ohio  State  Dental  Society. 
Research  Institute  of  the  National  Dental  Association. 
Special  American  Hospital  in  Paris  for  Wounds  of  the  Face  and  Jaws. 


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124  THE  DENTAL  DIGEST 

A  CLEFT  PALATE  CASE 
By  Dr.  G.  B.  Speer,  Los  Angeles,  California 

Let  us  say  Case  No.  i,  Donald ,  age  22,  came  to  my  office  Novem- 
ber, 1 9 14;  had  two  rubber  vellums,  was  never  able  to  wear  either  with 
comfort,  in  either  talking  or  eating;  in  fact,  could  talk  plainer  without- 
After  examination  he  followed  my  directions  and  went  to  the  Angeles 
Hospital.  Next  morning  at  eight  o'clock,  I  did  a  Brophy  operation- 
He  remained  in  the  hospital  one  week,  went  home  and  reported  to  my 
office  for  removal  of  lead  plates  and  sutures.  He  now  can  talk  to  strangers 
and  be  understood.  In  his  own  words,  he  says  he  thinks  a  school  teacher 
can  now  imderstand  him  and  he  is  going  to  go  to  night  school.  He  also 
says  people  do  not  notice  his  lip  any  more  and  he  can  whistle,  a  thing  he 
always  wanted  to  do  but  could  not. 

When  I  look  at  this  result  and  I  wonder  why  at  this  age  of  human 
progress  and  surgical  successes,  when  we  can  almost  say  a  man's  success 
is  only  limited  by  his  imagination,  for  we  must  remember  that  he  who 
seeks  to  discover  must  first  learn  to  imagine,  and  the  surgeon's  hand  only 
does  the  work  guided  by  the  imagination  brain,  and  all  that  is  necessary 
is  to  look  into  that  mouth  and  imagine  the  shape  that  palate  should  be. 
Then  with  his  hands  he  constructs  out  of  the  tissues  already  there  a 
palate,  shaping  it  as  it  should  be,  true  to  nature,  and  as  the  potter 
modeling  his  clay  has  to  allow  a  sufficient  excess  to  allow  for  the  shrinkage, 
so  we  allow  for  the  contractions  in  the  healing,  and  we  have  a  vellum 
worthy  of  the  name;  and  as  I  pen  these  few  words,  there  arises  in  my 
memory  a  vision  of  a  kindly  face,  surmounted  by  gray  hair  and  I  can 
almost  see  the  kindly  eyes  and  hear  the  kindly  voice  of  Doctor  Brophy, 
the  originator  of  the  Brophy  operation,  saying  that  the  time  for  rubber 
velliuns  was  past  years  and  years  ago,  and  I  go  further  and  say  there 
never  was  a  time  for  them,  for  surgery  should  have  preceded  them,  and 
there  would  never  be  need  or  cause  for  such  an  article  and  rubber  vellum, 
germ-breeding  pens  would  never  have  been  heard  of. 
Story  Building 

PROPHYLAXIS* 
By  Dr.  Franklin  B.  Roberts,  Pittsburg,  Pa. 

A  prophylaxis  treatment  requires  time  and  in  order  to  give  the  patient 
a  thorough  treatment  the  fee  charged  must  be  in  accord  with  the  time 
necessary  to  do  the  work  thoroughly.  First  of  all,  remove  all  deposits. 
A  mixture  of  carmi  cleanser,  glycerine,  a  drop  of  essence  of  peppermint 
and,  in  some  cases,  a  few  drops  of  peroxide  I  find  makes  a  good  paste  for 
polishing.    A  little  rubber  cup  made  by  Young  &  Co.,  I  find  excellent 

*Clinic  at  Odontological  Society  of  W.  Pa.,  1915. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     125 

for  use  with  the  engine.  This  little  cup  holds  the  paste,  does  not  cut  or 
irritate  the  gum,  is  soft  and  not  harsh  and  still  removes  all  stains.  The 
disclosing  solution  is  used  after  which  all  surfaces  are  gone  over  with  the 
hand  polisher  and  wooden  points.  For  deep  cusps  the  little  brush  used 
on  the  engine  is  useful.  The  approximal  surfaces  can  be  polished  very 
thoroughly  by  using  the  Kuroris  silk  ribbon  smeared  with  the  paste. 
For  the  high  polish  the  carmi  lustro  is  used,  keeping  both  tooth  and  lustro 
dry.  The  mouth  is  now  thoroughly  syringed  with  an  antiseptic  solution 
and  your  time  is  well  spent.  This  treatment,  in  my  experience,  I  find 
much  appreciated  by  my  patients,  and  should  be  repeated  every  two  or 
three  months  as  the  case  may  be  to  give  the  patient  the  best  results. 


[The  Dental  Outlook,  January,  1916] 
Contents 
Original  Communications 

•Importance  of  X-Ray  Diagnosis  in  Dentistry.    By  A.  M.  Nodine,  D.D.S. 
Discussion  of  Dr.  Nodine's  Paper.    By  Dr.  L.  Harris. 

The  Regents,  Dental  Education  and  the  Allied  Dental  Council.    By  M.  William,  D.D.S. 
Dental  College  by  next  October. 
Monthly  Report  of  Legislation  Committee  of  the  Allied  Dental  Council. 

Editorial 

1Q16 — ^A  Retrospect  and  a  Forecast. 
Letters  to  the  Editor. 

Book  Review 

Simplex  Handbook  of  Dental  Materia  Medica  and  Therapeutics. 
Students*  Department. 
Society  Activities. 

IMPORTANCE  OF  X-RAY  DIAGNOSIS  IN  DENTISTRY 

By  Alonzo  Milton  Nodine,  D.D.S. 

Oral  Surgeon  and  Dental  Consultant ^  French  Hospital;  Assistant  Dental  Radiologist,  New 
York  Throaty  Nose^  and  Lung  Hospital 

In  the  field  of  oral  surgery,  we  find  the  wrecks  and  wreckage  of  care- 
less, unsanitary,  septic,  and  sometimes  almost  criminal  dentistry.  I 
find  almost  75  per  cent,  of  the  oral  surgery  I  do  is  the  result  of  bad 
dentistry. 

When  these  patients  come  to  the  oral  surgeon — the  Court  of  Last 
Appeal — to  save  their  health  and  perhaps  their  life,  imagine  the  responsi- 
bility when  perhaps  the  skilled  efforts  of  all  others  of  the  healing  art  have 
given  no  relief.     Imagine  the  carnage  that  would  ensue  did  the  oral 


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126  THE  DENTAL  DIGEST 

surgeon  not  first  have  radiographs  of  the  teeth  and  jaws,  charts,  and 
surveys  of  these  organs. 

It  would  seem  almost  impossible  for  oral  surgery  to  have  attained 
the  high  standard  of  excellence  it  now  has  attained  if  the  use  of  the  X-ray 
had  been  denied  it. 

The  limitless  conditions  in  which  radiographs  serve  the  oral  surgeons 
are  too  numerous  to  mention.  But  oral  surgery  answers  that  question 
too  frequently  asked,  *'What  are  we  going  to  do  with  those  teeth  whose 
root  canals  we  cannot  fill?" 

Oral  surgery  tells  us  to  fill  those  canals  as  far  as  possible,  and  then 
resect  the  roots.  Oral  surgery  also  answers  that  other  question  asked, 
**What  are  we  going  to  do  with  those  teeth  which  we  cannot  cure 
of  a  chronic  apical  abscess?  "  Disinfect  and  fill  the  root  canals,  and  oral 
surgery  will  cut  out  the  granuloma  and  resect  the  septic  eroded  root  end. 

But  only  by  the  frequent  and  consistent  employment  of  the  X-ray 
is  it  possible  for  the  oral  surgeon  to  know  how  far  the  canal  is  filled  and 
the  extent  of  the  apical  infection. 

[The  Texas  Dental  Journal,  December,  1915] 
Contents 
Original  Communications 


Prevention  of  Decay. 

Oral  Surgery. 

Cotton  and  Explosives. 


With  Our  Contemporaries 


A  Consideration  of  Some  of  the  Present  Tendencies  in  Dentistry. 

Pellagra. 

The  Rotary  Code  of  Ethics  for  Business  Men  of  all  Lines. 

Personal  Observations  on  the  Brophy  Plan  of  Dealing  with  Complete  Clefts  of  the  Lip  and 

Palate. 
Tests  of  Leaking  Amalgam  Fillings. 
Cavity  Toilet  Preparations  to  the  Insertion  of  Synthetic  Porcelain. 

[The  Dental  Register,  December,  191 5] 

Contents 

Event  and  Comment. 

Professional  Ideals. 

The  Tooth  Brush. 

How  Should  Dentists  Advise? 

The  Human  Mouth. 

Bibliography. 

Index  to  Volume  LXTX. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE      12? 

[Oral  Healthy  December,  1915] 

Photograph— The  late  W.  T.  Stuart,  M.D. 

♦Centralized  Dental  Clinics  for  Children.     By  Harold  DeW.  Cross,  D.M.D.,  Boston. 
*Localized  Dental  Clinics  for  Children.    By  Wallace  Seccombe,  D.D.S.,  Toronto. 

Color  of  the  Teeth.    By  F.  H.  Orton,  D.D.S.,  Minneapolis. 

Interproximal  Space  and  Tooth  Form.    By  Charles  E.  Woodbury,  D.D.S.,  Council  Bluffs. 

Fibrous  Foodstuffs  and  Certain  Diseases. 

Obituary. 

Active  Service  Roll. 

Photograph,  Dr.  Harvey  J.  Burkhart,  Director  Rochester  Dental  Dispensary. 

Editorial. 

CENTRALIZED  DENTAL  CLINICS  FOR  CHILDREN 
By  Harold  DeW.  Cross,  D.M.D. 
{Director^  The  Forsyth  Dental  Infirmary^  Boston) 

The  Forsyth  extends  its  benefits  to  all  children  of  Boston  and  its 
suburbs  under  sixteen  years  of  age  whose  pecuniary  circumstances  pre- 
clude their  securing  the  services  of  a  private  dentist.  At  the  present 
time  this  pecuniary  eligibility  is  based  upon  maximum  of  $4  per  week 
per  person  in  the  family.  That  is,  if  the  family  income  is  $20  for  a  family 
of  five,  the  children  of  the  family  become  eligible.  The  number  of 
children  at  present  cared  for  is  between  four  and  five  hundrec^per  day. 
This  number  will  be  gradually  increased.  A  charge  is  made  of  five  cents 
for  each  visit. 

The  question  of  localized  clinics  was  very  carefully  considered  by  the 
Trustees  before  the  plan  of  a  central  clinic  was  finally  adopted.  The 
local  clinics  were  considered  unsatisfactory  because  (a)  It  was  exceed- 
ingly difficult  to  control  the  attendance  of  the  operator.  They  were 
liable  to  come  late,  to  leave  early,  and  possibly  not  to  come  at  all.  Very 
strict  supervision  was  found  necessary  to  improve  punctual  and  full 
attendance,  (b)  It  was  almost  impossible  to  exact  an  equal  standard 
of  work  done  in  the  different  clinics.  This  diflference  of  standard  quickly 
became  known  and  clinics  were  patronized  or  neglected  according  to  the 
standard  of  work  and  equipment  supplied,  (c)  A  suitable  equipment 
meant  an  expensive  reduplication  of  plant.  This  necessarily  occurred 
no  matter  how  inadequate  the  equipment  of  a  given  plant  might  be. 
It  further  meant  an  idle  equipment  in  many  instances  for  certain  hours 
of  the  day.  (d)  It  was  found  that  the  trained  dental  practitioner  was 
obliged  to  waste  a  greater  or  less  part  of  his  time  in  clerical  or  nursing 
work  and  by  attending  to  other  duties  than  his  strictly  professional 
services,  (e)  It  was  found  to  be  exceedingly  difl&cult  to  regulate  the 
purchase  and  cost  of  supplies  and  to  check  their  application,  (f)  And 
lastly,  it  was  found  that  the  providing  of  hygienic  and  septic  quarters 
was  almost  impossible. 


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12S  THB  DENTAL  DI6BST 

LOCALIZED  DENTAL  CLINICS  FOR  CHILDREN 
By  Wallace  Seccombe,  D.D.S.,  Toronto 

The  advantages  of  Dental  Clinics  established  in  the  school  buildings 
may  be  summarized  as  follows: 

1.  The  plan  is  less  costly. 

2.  School  discipline  gives  control  of  child  for  treatment  as  well  as 
follow-up  service. 

3.  Through  the  assistance  of  the  school  teacher,  the  daily  cleansing 
of  the  mouth  by  the  child  may  be  checked  up. 

4.  In  the  acquiring  of  good  dental  habits  of  mastication  and  oral 
cleanliness,  the  child  is  usually  influenced  more  by  the  teacher  than  by 
the  parent. 

5.  Complete  dental  statistics  regarding  oral  conditions  are  only  to 
be  obtained  through  the  systematic  dental  examination  of  children  in  the 
school  building. 

6.  Schools  are  becoming  more  and  more  educating  centres  for  the 
conrniimity  in  which  they  are  situated. 

7.  Dental  operators  are  under  same  regulations  regarding  hours  and 
discipline  as  are  members  of  the  teaching  staff. 

Disadvantages  of  a  central  clinic  as  they  appear  to  the  writer  are: 

1.  The  necessity  of  children  traveling  long  distances  with  the  con- 
sequent expense  of  transportation.  Ten  cents  for  car  fares  each  visit  is 
a  hardship  to  those  who  are  too  poor  to  pay  for  regular  dental  service. 

2.  In  cases  of  younger  children,  the  inconvenience  and  expense  of 
an  older  person  accompanying  the  child  each  sitting. 

3.  Lack  of  control  of  the  child  regarding  subsequent  sittings  and  the 
impossibility  of  the  daily  follow-up. 

4.  Lack  of  cooperation  between  school,  home  and  dental  clinic. 

In  presenting  these  facts  for  your  consideration,  the  writer  has  no 
thought  of  minimizing  the  possible  advantages  of  a  central  clinic  plan, 
but  would  urge,  in  view  of  our  experience  in  Toronto,  the  many  advan- 
tages of  following  the  school  system  which  has  already  been  thoroughly 
tried  across  the  water  and  found  most  practical  and  efficient. 

[New  York  Medical  Journal,  December  25,  1915] 

DECAYED  TEETH  AND  CANCER 

By  Alonzo  Milton  Nodine,  D.D.S.,  New  York. 

Oral  Surgeon  and  Denial  Consultant^  French  Hospital;  Assistant  Dental  Radiologist,  New 
York  Throaty  Nose,  and  Lung  Hospital 

One  woman  out  of  seven  and  one  man  out  of  eleven,  after  the  age 
of  thirty-five  years  die  of  cancer  in  England.     Cancer  is  sixth  in  the  list 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    129 

of  diseases  that  cause  death  in  the  United  States;  there  has  been  an 
average  of  73,800  deaths  from  cancer  for  the  last  ten  years.  In  New 
York  State,  in  1913,  9,528  deaths  were  caused  by  cancer.  Cancer 
caused  over  nine  times  as  many  deaths  as  typhoid  fever.  In  189 1,  cancer 
caused  3,000  deaths.  In  twenty  years  the  death  rate  has  increased 
166.66  per  cent.  If  this  rate  continues  for  another  twenty  years,  the 
death  rate  from  cancer  will  be  more  than  from  consumption. 

Different  estimates  indicate  that  from  nine  to  26.3  per  cent,  of  all 
cancers  are  found  on  the  tongue.  Still  others  declare  that  one  seventh 
to  two  fifths  of  all  cancers  are  found  in  the  mouth,  tongue,  lips,  or  jaws. 
Most  of  these  cancers  are  on  exposed  surfaces  where  they  should  be 
discovered  early,  operated  upon,  and  cured.  Equally  significant  is  the 
estimate  that  one  third  to  one  half  of  all  cancers  are  foimd  in  the  stomach 
and  duodenum. 

Whatever  may  be  the  underlying,  imdiscovered  cause  of  cancer,  there 
seems  to  be  no  question  that  the  exciting  cause  is  irritation.  This  irrita- 
tion may  be  caused  by  chemicals,  bums,  injuries,  or  inflammatory  dis- 
eased conditions.  Dynamite  is  harmless  until  irritated;  and  whatever 
causes  cancer  is  harmless  until  irritated.  The  two  regions  of  the  body 
most  subjected  to  chronic  irritation  are  the  mouth  and  the  stomach. 

Cancer  is  one  of  the  diseases  for  which  modem  civilization  is  held 
responsible.  Furthermore  tooth  decay  is  the  most  widespread  and 
prevalent  disease  for  which  modem  civilization  is  responsible.  Eighty 
to  ninety-eight  per  cent,  of  the  school  children  of  the  United  States  have 
decayed  teeth,  and  there  is  little  doubt  that  the  same  rate  prevails  with 
the  adult  population.  Decayed  teeth  are  due,  to  a  very  great  extent, 
to  our  modem  demineralized,  devitamized  diet,  as  well  as  to  haste  in 
eating,  nervous  tension,  lack  of  exercise,  methods  of  cooking,  and  all  that 
goes  with  our  manner  of  living. 

The  particular  irritation  that  is  frequently  found  to  cause  cancer  in 
the  mouth  is  the  sharp  edge  of  a  decayed,  wom,  misplaced,  or  tartar 
covered  tooth.  The  constant  rubbing  of  the  tongue,  cheek,  or  lips  over 
such  a  tooth  produces  an  abrasion,  an  abrasion  develops  into  a  sore,  and 
from  a  sore  it  may  pass  on  through  various  stages  to  cancer.  The 
irritation  produced  by  the  sharp  edge  of  a  broken  or  poorly  fitting  plate, 
bridge,  crown,  or  filling  has  caused  cancer  of  the  mouth. 

Cancerous  growths  may  also  spring  from  the  irritated  and  injured 
gum  surroimding  decayed  and  broken  down  teeth.  Polyps  grow  from 
irritated  tooth  pulps.  Bony  growths  result  from  chronic  inflammation 
of  the  covering  of  tooth  roots.  Injury  to  the  bony  support  of  teeth  by 
extraction  has  resulted  in  the  development  of  cancerous  growths  in 
these  locations. 


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130  THB  DENTAL  DIGBST 

The  chronic  irritation  of  an  abscessed  tooth,  the  irritation  of  decayed 
roots,  impacted  teeth  and  unerupted  teeth,  lower  the  resistance  of  the 
surrounding  tissue  and  invite  the  development  of  cancer.  Diseased  and 
uncleansed  teeth  and  gums  are  sufficiently  irritating  to  produce  inflamma- 
tion and  ulceration  of  any  part  of  the  mouth.  It  is  not  unreasonable  to 
believe  that  conditions  such  as  these  produce  cancer  of  the  mouth. 

That  there  are  other  causes  which  produce  cancer  of  the  mouth  and 
jaws  is  unquestioned,  but  it  must  not  be  lost  sight  of  that  in  such  con- 
ditions, as  have  been  described  lie  the  possibilities  of  cancer.  In  fact, 
there  are  records  of  a  great  number  of  cases  which  show  that  cancer  has 
developed  from  such  conditions.  There  is  the  classical  example  of  Gen- 
eral Grant. 

In  New  York  State,  in  1913,  291  deaths  occurred  from  cancer  of  the 
mouth,  and  in  January,  1914,  thirty  deaths  1  Mayo,  Moynihan,  and 
other  surgeons  and  stomach  specialists  estimate  that  45  to  90  per  cent., 
perhaps  all  cases  of  cancer  of  the  stomach,  originate  at  the  site  of  an  ulcer 
of  the  stomach  or  duodenum. 

Among  the  most  frequent  causes  of  ulcer  of  the  stomach  are  unmasti- 
cated  food,  too  much  food,  and  the  constant  swallowing  of  the  contents  of 
a  diseased  and  unclean  mouth.  Food  is  not  chewed  or  bolted  either  from 
habit  or  haste,  or  because  decayed,  diseased,  deformed,  or  deficient  teeth 
make  proper  chewing  difficult,  if  not  impossible. 

Large  quantities  of  unchewed  food,  and  the  microorganisms  and  toxins 
from  diseased,  decayed  teeth  and  gums  injure  the  lining  of  the  stomach 
either  by  impaction  or  stagnation,  or  else  change  or  disorganize  the  pro- 
duction of  the  digestive  secretions.  The  coating  of  the  stomach  also 
becomes  infected  during  these  resting  periods  between  meals,  when  the 
hydrochloric  acid  is  not  poured  into  the  stomach.  The  function  of  the 
hydrochloric  acid  is  to  neutralize,  retard,  and  destroy  the  dangerous 
microorganisms  and  their  toxins  taken  in  with  food. 

The  abnormal  decomposition  of  food  in  the  stomach  due  to  the  inter- 
ference with  production  of  the  proper  amount  of  hydrochloric  acid, 
results  in  the  manufacture  from  food  of  other  acids,  such  as  lactic,  acetic, 
and  butyric.  These  make  the  scomach  excessively  acid.  This  highly 
acid  condition  is  sufficiently  irritating  to  injure  the  coating  of  the  stomach 
and  cause  gastric  ulcer.  A  large  amount  of  food,  or  hard  unchewed  food 
entering  such  a  stomach,  the  churning  movements  further  increase  the 
irritation  already  begun  by  the  abnormal  acids. 

Rosenow  has  experimentally  proved  that  one  particular  microorgan- 
ism found  in  unhealthy  mouths  is  capable,  when  carried  by  the  blood, 
of  lodging  in  the  wall  of  the  stomach  and  producing  gastric  ulcer. 

The  employment  of  the  X-ray  by  the  dentist  assists  in  the  discovery 


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AN  BPITOM£  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     131 

of  cancerous  and  precancerous  conditions.  This  diagnostic  agent  should 
be  more  frequently  employed  by  physicians  and  dentists  in  all  cases  of 
suspicious  swellings  and  enlargements. 

A  great  amount  of  evidence  shows  that  one  of  the  most  certain  meas- 
ures to  prevent  cancer,  either  in  the  mouth  or  stomach,  is  sound,  clean 
teeth.  Lost  teeth  should  be  replaced  with  artificial  substitutes  so  that 
food  may  be  properly  chewed.  In  addition,  dental  defects  should  be 
corrected,  decayed  teeth  should  be  treated  and  filled,  and  all  unreclaimable 
teeth  or  roots  removed;  and  all  artificial  fixtures,  such  as  bridgework  or 
plates  should  be  made  smooth,  sanitary,  and  unirritating.  Diseased 
gums  should  be  treated  to  prevent  the  oozing  into  the  mouth  of  pus  and 
poisonous  toxins  that  are  found  in  such  foul  conditions.  Tartar  should 
be  removed  from  the  teeth  frequently  and  thoroughly,  and  the  teeth 
cleansed  and  polished  by  a  dentist  or  dental  nurse.  Finally,  teeth  should 
be  brushed  carefully  and  thoroughly  with  a  good  tooth  paste,  powder,  or 
lime  water,  or  lemon  juice  and  water,  after  eating  and  upon  going  to  bed. 

RONTGEN  DISCOVERY  AND  ITS  RECENT  DEVELOPMENT  AND  FUTURE 

POSSIBILITIES 

By  W.  D.  Coolidge,  M.  D.,  Schenectady,  N.  Y. 

Early  attempts  to  show  diffraction,  refraction,  and  reflection  had 
all  failed.  In  191 2,  Lane  predicted  that  if  the  X-rays  were  passed 
through  a  crystal,  interference  effects  would  be  produced  just  as  they 
are  when  ordinary  light  falls  on  a  Rowland  grating.  The  experiment 
was  tried  by  Freidrich  and  Knipping  and  proved  completely  successful. 

Bragg  later  showed  that  regular  reflection  of  X-rays  can  be  made  to 
take  place  from  the  cleavage  surfaces  of  crystals.  A  secondary  wavelet 
spreads  out  from  each  atom  as  a  primary  wave  passes  over  it. 

The  work  of  Laue  and  Bragg  has  made  it  possible  to  measure  the  wave 
length  of  the  X-rays,  and  shows  them  to  be  a  transverse  vibration  travel- 
ing with  the  velocity  of  light  and  with  a  wave  length  about  one  ten 
thousandth  that  of  ordinary  light. 

Moseley  and  Darwin  have  found  that  each  element,  when  placed  in 
the  path  of  X-rays  of  sufficiently  high  penetration,  gives  off  secondary 
rays  with  a  wave  length  characteristic  of  the  particular  substance  in 
question.  This  serves,  not  only  as  a  useful  method  of  analysis,  but  also 
as  the  basis  of  a  logical  method  for  grouping  the  elements. 

FUTURE  POSSIBILITIES 

I.  As  our  source  of  X-rays  become  more  and  more  intense,  new 
fields  of  usefulness  are  opening  up  The  germicidal  and  sterilizing  action 
may  be  commercially  useful  in  connection  with  food  products,  etc. 


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132  THE  DENTAL  DIGEST 

2.  They  may  be  useful  as  an  ionizing  agent  to  bring  about  chemical 
reactions. 

3.  It  is  now  possible  to  produce  cathode  rays  having  a  velocity 
comparable  with  that  of  the  most  rapidly  moving  beta  rays  from  the 
radioactive  substances,  and,  at  the  same  time,  we  get  X-rays  comparable 
in  penetrating  power  with  the  most  penetrating  gamma  rays.  We  are 
also  able  to  produce  canal  rays  which  are  like  the  alpha  rays,  except 
that  they  have  lower  velocity.  These  three,  together  with  metallic  lead, 
constitute  the  decomposition  products  of  radioactive  substances,  and  it 
therefore  seems  possible  that  we  may  some  day  be  able  to  produce  these 
radioactive  substances  synthetically. 

4.  As  we  are-  now  able  to  put  energy  into  the  atom,  and  as  we  are 
now  getting  more  and  more  of  an  insight  into  the  structure  of  the  atom, 
it  does  not  seem  too  much  to  hope  that  we  shall  some  day  be  able  to 
transmute  the  elements  at  will  and  to  store  up  large  quantities  of  available 
energy  in  small  masses. 

5.  It  seems  probable  that  such  work  as  that  now  being  done  by  the 
physicist,  on  alpha  ray  scattering  and  with  the  X-ray  spectrometer,  will 
lead  to  much  higher  efficiency  of  X-ray  production.  The  desirability  of 
this  is  obvious  when  we  think  that  at  present  we  are  able  to  utilize  only 
about  0.2  per  cent,  of  the  energy  which  is  put  into  the  tube. 

This  means  that  if  we  could  raise  this  efficiency  to  100  per  cent,  and 
could  suitably  direct  the  rays,  we  should  put  into  the  tube,  for  say  a 
stomach  plate,  not  four  kilowatts,  but  only  eight  watts.  In  other  words, 
we  should  then  need  in  the  tube  much  less  energy  than  we  now  consume 
in  the  ordinary  hand  battery  flash  lamp.  I  do  not  mean  to  give  the 
impression  that  the  work  of  the  physicist  has  yet  revealed  a  method 
for  making  the  transformation  of  electrical  X-ray  energy  much  more 
efficient  than  it  is  now;  but  it  does  seem  probable  that  with  more  detailed 
knowledge  of  the  mechanism  of  X-ray  production,  and  this  means  more 
knowledge  of  the  structure  of  the  atom,  that  we  shall  some  day  be  able  to 
help  ourselves  in  this  direction. 

6.  Another  dream  which  should  come  true  some  day,  is  the  pro- 
duction of  a  substance  capable  of  making  a  screen  say  a  thousand  times 
more  sensitive  than  anything  we  have  now.  For  relatively  little  is  known 
about  the  mechanism  of  fluorescence.  The  whole  subject  is  one  of  the 
greatest  interest  and  undoubtedly  stands  in  very  close  relation  to  the 
production  of  secondary  X-rays.  Seeing,  as  we  now  do,  the  widest 
range  in  the  fluorescent  power  shown  by  different  substances,  and 
with  the  mechanism  so  little  understood,  it  does  not  seem  too 
much  to  hope  that  the  efficiency  of  this  energy  transformation  may 
also    be    tremendously    increased.      Most,    if    not    all     the    energy 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE      133 

absorbed  by  the  screen  is  now  transformed,  but  the  amount  aosorbed 
very  small. 

%^  7.     Similarly,  it  does  not  seem  too  much  to  hope  that,  with  our  rapidly 

^  ising  knowledge  of  characteristic  radiations,  we  shall  some  day  see  a 

^.  raphic  plate  in  which  a  much  larger  fraction  of  the  X-ray  energy 

V-  ed  with  a  corresponding  increase  in  speed.     From  the  diagnostic 

^v  '-  ^^  increase  in  screen  and  plate  sensitiveness  is  perhaps  much 

^  desired  than  is  a  more  powerful  or  more  efficient  sources  of 

^e  former  would  reduce  the  danger,  while  the  main  effect  of 

.ould  be  on  the  pocket  book. 

With  the  ability  to  get,  as  we  now  can,  characteristic  radiations 

i  definite  wave  length,  the  germicidal  and  physiological  actions  can  be 

scientifically  studied,  with  the  possibility  of  finding  out  whether  there  is, 

for  a  definite  purpose,  any  specificity  of  action  so  that  a  certain  cell 

responds  more  strongly  to  a  certain  wave  length  than  to  any  other. 

[New  York  Medical  Journal,  January  8,  19 16] 

[Presse  MidicaL    October  25,  191 5] 

FRACTURES  OF  THE  INFERIOR  MAXILLARY  BONE  IN  MILITARY 

PRACTICE 

By  L.  Imbert  and  P.  Real 

From  experience  with  a  large  number  of  cases  the  authors  have  been 
led  to  establish  a  clinical  division  into  fractures  of  the  anterior  group,  in 
which  the  line  of  fracture  is  somewhere  between  the  canine  teeth  and  the 
midline,  and  fractures  of  the  posterior  group,  in  which  it  is  lateral  to  the 
canine  teeth.  In  the  former  group  the  displacement  is  not  sufficient  to 
cause  overlapping  of  the  fragments,  the  teeth  on  the  side  of  the  fracture 
practically  retain  their  normal  relationship  to  the  upper  teeth,  and  the 
functional  result,  provided  that  bony  union  takes  place,  is  not  very  bad. 
In  fractures  of  the  posterior  group,  on  the  other  hand,  a  symmetry  results 
from  overlapping  of  the  fragments.  The  chin  is  displaced  toward  the 
fractured  side  and  the  unaffected  side  appears  more  prominent,  though 
regular  in  profile.  Again,  there  may  be  abnormal  prominence  on  the 
affected  side,  due  partly  to  outward  displacement  of  the  short  fragment, 
partly  to  swelling  of  the  soft  tissues,  and  perhaps  partly  to  the  presence 
of  callus.  Behind  this  prominence,  the  profile  appears  flattened,  owing 
to  obliquity  of  the  short  fragment  and  disappearance  of  the  angle  of  the 
jaw  from  the  surface.  An  important  sign  of  this  variety  of  fracture  is 
elicited  by  taking  three  points  on  either  side  of  the  jaw — the  angle, 
condyle,  and  midline — and  joining  these  by  imaginary  lines. 


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134  THE  DENTAL  DIGEST 

[Medical  Record,  January  8,  1916] 

FECAL  INFECTIONS 

Drs.  W.  C.  Mayes,  W.  Wilson,  and  C.  F.  Wilson  of  Memphis,  from 
their  limited  experience,  drew  the  following  conclusions:  (i)  That  many 
diseases,  the  etiology  of  which  has  been  obscure,  are  undoubtedly  due  to 
metastasis  or  absorption  of  toxins  from  a  primary  focal  infection.  (2) 
We  do  not  believe  that  we  have  done  our  whole  duty  to  a  patient  by 
simply  treating  the  results  of  a  metastatic  infection  or  the  symptoms  of 
toxic  absorption.  (3)  It  is  absolutely  essential  to  remove  the  primary 
focus  when  possible  or  at  least  overcome  the  infection  in  the  same  in 
order  to  conserve  the  best  body  economy.  (4)  That  in  the  diseases  due 
to  focal  infection,  if  a  cure  is  not  effected  by  the  removal  of  a  diseased 
focus,  or  if  further  metastasis  occurs,  the  focus  removed  was  not  the 
causative  or  only  causative  focus,  and  a  further  search  should  be  made 
with  a  view  to  its  removal  or  cure.  (5)  That  if  the  focus  cannot 
be  removed,  or  the  infection  in  the  same  controlled,  for  anatomical  rea- 
sons, often  the  removal  of  a  diseased  tonsil,  draining  an  apical  dental 
abscess,  or  accessory  nasal  sinuses  will  allow  the  body  economy  to  so 
recuperate  that  a  cure  will  occur  in  the  original  offending  focus.  (6) 
That  an  innocent  appearing  tonsil  may  be  the  focus,  and  that  the  search 
for  the  offending  focus  is  not  complete  without  exhausting  every  aid  of 
the  laboratory.  X-ray,  and  our  own  diagnostic  ability. 

[New  York  State  Journal  of  Medicine,  December,  1915] 

CONCERNLXG   MOUTH  INFECTIONS  AS  RELATED  TO  SYSTEMIC  DISEASE 
By  S.  Marx  White,  B.S.,  M.D. 

The  problem  of  eradication  of  dental  foci  of  infection  differs  radically 
from  that  presented  in  the  tonsils.  In  the  case  of  the  tonsil,  the  clinical 
evidences  of  infection  may  be  difficult  to  secure.  One  who  has  sys- 
tematically attempted  to  eradicate  focal  infections  will  be  often  called 
upon  to  insist  upon  the  removal  of  a  fairly  innocent-looking  pair  of  tonsils 
even  in  the  face  of  statements  by  competent  nose  and  throat  surgeons 
that  the  tonsils  do  not  appear  diseased.  We  frequently  see  infection 
arising  from  tonsils  which  are  small,  buried  and  adherent  to  the  pillars 
and  that  show  no  external  sign  of  inflammation,  except  possibly  a  streak 
of  reddening  along  the  pillar.  Such  tonsils  are  as  frequently  the  source 
of  systemic  dissemination  as  the  frankly  and  evidently  inflamed  ones. 
Where  such  tonsils  exist  and  where  there  is  no  clear  evidence  of  some 
other  focal  infection,  the  need  for  tonsillectomy  rests  more  upon  whether 
there  is  evidence  of  systemic  infection  from  some  focus  than  upon  the 
apparent  condition  of  the  tonsil  itself.    As  a  result  of  this  attitude  we 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    135 

have  been  frequentiy  rewarded  by  having  the  pathologist,  after  removal 
of  the  tonsils,  find  definite  evidences  of  active  inflammation  were  lacking. 

At  the  present  time,  we  have  no  more  definite  clinical  criteria  of  in- 
fection in  the  tonsils  than  I  have  outlined  above.  The  demonstration  of 
streptococci  and  other  organisms  on  the  surface  or  in  the  crypts  of  tonsils 
in  clinical  cases  is  conclusive  only  of  their  existence  there.  No  certain 
means  of  securing  uncontaminated  cultures  from  the  depth  of  tonsils, 
clinically,  is  known  to  the  writer. 

The  case  is  very  different  as  concerns  the  teeth  and  jaws.  Here  the 
dentist  can,  by  proper  heat  and  electricity  tests,  determine  whether 
teeth  are  living  ones  or  not:  and  the  rontgenogram,  with  proper  technic 
and  experience,  can  give  evidences  suggestive  of  infective  processes 
about  the  teeth  or  anywhere  in  the  tissues  of  the  jaw.  The  technic  and 
details  of  rontgenographic  study  are  matters  for  the  technician,  and  a 
large  experience  is  necessary  before  a  properly  qualified  opinion  can  be 
expressed. 

While  the  ordinary  root  abscess  is  easy  of  recognition,  a  great  deal 
remains  to  be  learned  as  to  the  significance  of  the  minor  grades  of  absorp- 
tion about  the  roots.  It  appears  to  be  true  also  that  in  many  instances  a 
focus  of  infection  has  been  absorbed,  and  restitution  of  the  tissues  of 
the  alveolar  process  has  occurred,  leaving  a  modified  rontgenographic 
field.  The  nature  and  significance  of  these  modifications  still  remains 
to  be  worked  out. 

It  would  appear  to  be  a  simple  matter,  once  abscesses  or  infected  teeth 
have  been  found,  to  decide  what  procedure  should  be  adopted;  but,  on 
the  one  hand,  the  clinician,  anxious  to  eradicate  all  foci  of  infection,  de- 
mands that  infected  teeth  be  extracted:  the  dentist,  anxious  to  retain 
the  best  occlusal  surfaces  and  masticating  mechanism  for  the  patients, 
desires  to  remove  only  the  infected  tissues  and  retain  as  much  as  possible 
of  the  tooth.  The  application  to  each  individual  case  should  be  deter- 
mined, not  by  the  physician  alone,  nor  by  the  dentist  alone,  but  by  both 
together,  giving  proper  consideration  to  the  needs  of  the  patient,  the 
possibility  of  the  dental  procedures  to  eradicate  all  infection  and  still 
retain  a  masticating  surface,  and  finally,  the  ability  of  the  individual 
dental  operator  involved,  so  far  as  securing  results  is  concerned. 

Dentists  have  built  up  a  marvelous  mechanical  perfection  in  crown 
and  bridge  work,  but  at  the  same  time  have  developed  conditions  inviting 
infection  of  the  alveolar  process.  Because  so  often  free  from  local  symp- 
toms and  signs,  this  infection  has  remained  hidden  until  brought  to  light 
by  the  rontgenogram.  The  infection  must  be  eradicated,  but  so  far  as 
possible,  our  patients  must  be  spared  the  inconvenience  and  disability  of 
artificial  teeth,  and  the  conservative  dentist  must  learn  as  far  as  possible 


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136  THE  DENTAL  DIGEST 

to  eradicate  the  infection  and  spare  the  tooth.  In  this  problem  the 
physician  has  a  vital  interest. 

One  additional  point  needs  particular  attention  by  the  physician. 
It  is  that,  if  extraction  or  other  operative  work  is  to  be  employed,  care 
should  be  exercised  not  to  overdo  or  to  attack  too  many  foci  at  one  time. 
In  this  field  the  infections  are  usually  very  chronic,  and  there  is  no  urgent 
demand  for  the  immediate  eradication  of  all  foci. 

Two  considerations  demand  that  all  foci  should  not  be  eradicated  at 
once.  The  first  is  that  in  case  vaccines  or  bacterins  are  needed,  if  all  foci 
have  been  eradicated  and  attempts  at  cultivation  of  bacteria  have  failed 
or  gone  awry,  material  for  culture  can  no  longer  be  secured. 

Secondly,  the  measures  necessary  for  elimination  of  the  infection  fre- 
quently stir  up  and  increase  the  infection  at  the  time  and  there  is  con- 
siderable danger,  particularly  in  heavily  infected  individuals,  of  opening 
up  many  channels  of  infection,  of  severe  local  reactions,  sometimes  with 
necrosis,  and  frequently  of  aggravating  a  multiple  joint  infection,  or 
even  an  endocardial  or  myocardial  involvement.  These  dangers  are  real, 
and  we  have  had  several  illustrations  of  the  folly  of  attempting  to  eradi- 
cate multiple  foci  at  one  time.  Here  again  it  is  necessary  that  the 
physician  and  dentist  confer  and  take  fully  into  account  such  possibilities. 


DEATHS 

Harrison,  Dr.  H.  H.,  died  at  Wheeling,  W.  Va.,  December  17, 
1915,  in  his  76th  year. 

Allen,  Dr.  Chas.  H.,  died  December  30th,  1915,  at  New  Milford, 
Conn.,  from  the  result  of  an  accident.  Dr.  Allen  was  bom  at  Norwalk 
on  March  8,  1859  and  came  to  New  Milford  35  years  ago  to  practise 
dentistry.  He  lived  a  quiet,  forceful  life,  building  up  a  reputation  for 
efficiency  in  his  profession.  He  is  very  much  mourned  by  his  many 
friends. 

Ervin,  J.  J.  Dr.,  died  December  23rd,  1915,  at  Elmira,  N.  Y.  Dr. 
Ervin  was  born  in  Elmira,  N.  Y.,  June  ist,  1886.  He  was  educated  in 
the  schools  of  Elmira  and  graduated  from  the  University  of  Pennsyl- 
vania in  1907. 

He  was  a  member  of  the  Elmira  Dental  Society,  Sixth  District 
Society  of  New  York  and  the  National  Dental  Society. 


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FUTURE  EVENTS  137 


AN  INVITATION 

The  National  Dental  Association  and  all  ethical  dentists  will  be  heartily  welcomed  by 
the  profession,  the  business  men  and  the  citizens  of  Louisville  at  the  twentieth  annual  con- 
vention of  this  organization,  to  be  held  in  our  city  four  days  conmiencing  Tuesday,  July  25, 
1916. 

The  First  Regiment  Armory,  in  whose  54,000  square  feet  of  floor  space  the  exhibition  will 
l)e  held;  the  public  school  building,  in  whose  thirteen  commodious  rooms  the  clinics  will  be 
held;  Keith's  and  Macauley's  theatres,  the  auditoriums  of  the  Seelbach  and  Watterson  hotels, 
where  section  meetings  will  be  held,  are  within  a  radius  of  100  yards,  and  with  the  approval  of 
President  Hinman,  the  most  convenient  arrangements  e\'er  provided  have  been  made  for  the 
forthcoming  dental  convention. 

The  Kentucky  Dental  Association  will  hold  its  annual  meeting,  to  close  Monday,  July 
24th.  The  National  Association  of  Dental  Examiners  will  hold  its  convention,  arranging  to 
close  Monday,  July  24th.  The  three  Greek  letter  dental  fraternities  will  hold  their  annual 
conventions  Monday  July  24th. 

Louisville  is  the  ideal  convention  city  of  America,  convenient  of  access  from  all  points  of 
the  country,  abundant  in  its  hotel  accommodations  and  affording  innumerable  side  attrac- 
tions of  interest. 

The  local  committees  are  planning  a  series  of  entertainments  commensura  tewith  Ken- 
tucky's reputation  for  hospitality,  and  the  ladies  especially  who  attend  the  convention  will  be 
guests  at  innumerable  social  functions. 

Local  Conunittee — W.  T.  Farrar,  Chairman,  519  Starks  Building,  Louisville,  Ky.;  John 
H.  Buschemeyer,  Mayor  of  Louisville;  Fred  W.  Keisker,  President  Louisville  Convention 
and  Publicity  League;  Thos.  J.  Smith,  President  Louisville  Board  of  Trade;  Richard  II. 
Menefee,  President  Louisville  Commercial  Club;  W.  H.  Stacy,  President  Kentucky  State 
Dental  Association;  H.  B.  Tileson,  Max  M.  Ebel,  W.  M.  Randall,  R.  F.  Canine,  J.  W.  Clark, 
E.  A.  R.  Torsch,  I.  H.  Harrington,  W.  E.  Grant,  Ed.  M.  Kettig. 


FUTURE  EVENTS 


February  11-12,  1916. — The  thirty-third  Annual  Meeting  of  the  Minnesota  State  Dental 
Association,  at  the  University  of  Minnesota,  Minneapolis.— Max  E.  Ernst,  614  Lowry 
Bldg.,  St.  Paul,  Minn.,  Secretary. 

February  16-18,  1916. — The  Tenth  Annual  Clinic,  Manufacturers'  and  Dealers*  Exhibit  of 
the  Marquette  University  Dental  Alumni  Association,  Milwaukee  Auditorium,  Mil- 
waukee, Wis. — V.  A.  Smith,  Secretary, 

February  18-19,  1916. — Buffalo  Alumni  Association,  Hotel  Iroquois,  Buffalo,  N.  Y. — Grv 
M.  FiERO,  Buffalo,  Chairman  Executive  Committee, 

F*ebruary  21-22,  1916. — Golden  Jubilee  of  the  Washington  University  Dental  School,  at  the 
Dental  School,  29th  and  Locust  Sts.,  St.  Louis,  Mo. — H.  M.  Fisher,  Metropolitan  Bldg., 
Secrelary. 

February  23-24,  1916.  —  Central  Pennsylvania  Dental  Society,  Johnstown,  Pa.  —  C.  A. 
Matthews,  Chairman  Exhibit  Committee. 

March  14,  1916. — Fox  River  Valley  Dental  Society,  Appleton,  Wis. — R.  J.  Chady,  Oshkosh, 
Wb.,  Secretary, 

March  20-26,  1916. — TheTri-State  Post  Graduate  Dental  Meeting  (Missouri,  Kansas,  Okla- 
homa), Kansas  City,  Mo. — C.  L.  Lawrence,  Enid,  Okla.,  Secretary. 

March  23-25,  1916. — Sixth  District  Dental  Society,  Binghamton,  N.  Y.,  Hotel  Bennett. — 
William  A.  Ogden,  Chairman  Arrangement  Committee. 

March  25,  1916. — Maryland  State  Dental  Association,  Baltimore,  Md. — F.  F.  Drew, 
Baltimore,  Md.,  Secretary. 


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138  THE  DENTAL  DIGEST 


April  4-7,  191 6. — Dental  Manufacturers'  Club,  Chicago,  III.    Meeting  in  the  Banquet  Hall, 

Auditorium  Hotel. — Chairman  ExhiM  Committee,  A.  C.  Clark,  Grand  Crossing,  Chicago. 
April  II,  1916. — Alabama  Dental  Association,  Mobile,  Ala. 
April  13-15,  1916. — Michigan  State  Dental  Society,  Detroit,  Michigan. — Clare  G.  Bates, 

Secretary. 
April  12-14, 191 6. — West  Virginia  State  Dental  Association,  Kanawha  Hotel,  Charleston. 
May,  1916. — LAke  Erie  Dental  Association,  Erie,  Pa. — J.  F.  Smith,  Secretary, 
May,  1916. — Susquehanna  Dental    Association,  Scranton,  Pa. — Geo.  C.  Knox,  30  Dime 

Bank  Bldg.,  Scranton,  Pa.,  Recording  Secretary. 
May,  1916. — Indiana  State  Dental  Association,  Claypool  Hotel,  Indianapolis,  Ind. — A.  R. 

Ross,  Secretary. 
May  2-4,  19 1 6. — Iowa  State  Dental  Society,  Des  Moines,  la.    H.  A.  Elmquist,  Des  Moines, 

la.,  Chairman  of  Exhibit. 
May  3-5,  1916. — Massachusetts  Dental  Society,  Boston,  Mass. — A.  H.  St.  C.   Chase 

Boston,  Mass.,  Secretary. 
May  9-10,  1916. — North  Dakota  State  Dental  Association. — A.  Hallenberg,  Faigo,  No. 

Dak.,  Chairman  Exhibit  Committee. 
May  9-12,  1916. — Texas  State   Dental  Association,  Dallas,  Tex. — W.  O.  Talbot,  Fort 

Worth,  Tex.,  Secretary. 
May  9-12,  1916. — Illinois  State  Dental  Society,  Springfield,  Mass. — Henry  L.  Whipple, 

Quincy,  Mass.,  Secretary. 
May  1 1-13, 1916.— Dental  Society  of  the  State  of  New  York,  Hotel  Ten  Eyck,  Albany,  N.  Y.— 

A.  P.  BuRKHART,  52  Genesee  St.,  Albany,  N.  Y..,  Secretary. 
June,  1916. — Florida  State  Dental  Society,  Orlando,   Fla. — M.  C.  Izlar,  Corresponding 

Secretary. 
June  1-3,  1916. — Northern  Ohio  Dental  Association,  Cleveland,  O. — Clarence  D.  Peck, 

Sandusky,  O.,  Secretary. 
June  8-10,  1916. — Georgia  State  Dental  Society,  Macon,  Ga.     M.  M.  Forbes,   Candler 

Bldg.,  Atlanta,  Ga.,  Secretary. 
June  13-15,  1916. — Connecticut  State  Dental  Association,  Hotel  Griswold,  New  London, 

Conn. — Elwyn  R.  Bryant,  New  Haven,  Conn.,  Secretary. 
June  20-22,  1916. — New  Hampshire  Dental  Society,  Lake  Sunapee,  2^-Nipi  Park  Lodge, — 

Lisbon,  N.  H,-J.  E.  Collins,  Chairman  Exhibit  Committee. 
June  27-29,  1916. — Pennsylvania   State   Dental   Society,    Pittsburgh,    Pa. — Luther   M. 

Weaver,  7103  Woodland  Ave.,  Philadelphia,  Pa.,  Secretary. 
June    28-30,  191 6. — North    Carolina    State   Dental    Society,    Asheville,   N.    C. — R.    M. 

Squires,  Wake  Forest,  N.  C,  Secretary. 
July  II,  1916. — South  Carolina  State  Dental  Association,  Chick's  Springs,  S.  C. — Ernest 

C.  Dye,  Greenville,  S.  C,  Secretary. 
July   11-13,   1916. — Wisconsin  State  Dental   Society  Meeting,  Wausau. — Theodore  L. 

Gilbertson,  Secretary. 
July  12-15,  1916. — ^New   Jersey   State   Dental    Society,   Asbury   Park,   N.    J. — ^John   C. 

Forsyth,  Trenton,  N.  J.,  Secretary. 
July  20-23,  191 6. — American  Society  of  Orthodontists.    Address  communications  to  F.  M. 

Castro,  520  Rose  Bldg.,  Cleveland,  Ohio. 
July  25-28,  1 9 16. — National  Dental  Association,  ist  Regiment  Armory,  Louisville,  Ky. — 

Otto  U.  King,  Huntington,  Ind.,  Secretary. 
October  18-20,  1916. — Virginia  State  Dental  Association,  Richmond,  Va. — C.  B.  Gifford, 

Norfolk,  Va.,  Corresponding  Secretary. 


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The  Dental  Digest 

GEORGE  WOOD  CLAPP,  D.D.Sm  Editor 

Published  monthly  by  The  Dentists'  Supply  Company,  Candler  Bldg., 
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Articles  intended  for  publication  and  correspondence  regarding  the  same 
shoold  be  addressed  Editor  Dental  Digest,  Candler  Bldg.,  Times  Square, 
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The  editor  and  publishers  are  not  responsible  for  the  views  of  authors  ex- 
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Entered  as  Second  Class  Matter,  at  the  Post-Office*  at  New  York  City. 
Under  the  Act  of  Congress,  March  3,  iSyg.  ^'-. 


Vol.  XXII 


MARCH,  1916 


No.  3 


CLOSED  MOUTH  IMPRESSIONS* 

By  Samuel  G.  Supplee,  New  York,  N.  Y. 


THIRD   PAPER 

The  more  I  study  impression  taking  the  more  I  become  convinced  that 
while  proper  manipulation  of  modelling  compound  is  not  all  of  impres- 
sion taking,  there  can  be  no  first  class  impression  without  proper  manip- 
ulation of  modelling  compound. 

Furthermore,  I  feel  quite  sure  that  the  old  method  of  heating  a.  pan  of 
water  over  a  flame  and  dropping  compound  into  it  to  be  softened  is  not 
only  no  t  the  best  means  of  preparing  the  compound  for  the  impression ,  but 
that  it  is  so  far  inferior  to  more  recent  methods  of  heating  water  for  this 
pur})ose,  that  only  by  constant  attention  to  the  compound  while  heating 
thus  can  it  be  properly  softened. 

Mr.  Supplee  has  done  much  to  perfect  methods  of  preparing  the  com- 
pound for  impression  taking  as  well  as  to  improve  the  methods  for  its 
use  in  the  mouth. — Editor. 

VALUABLE   HINTS    ON   THE   USE    OF   MODELLING   COMPOUND 
FLOWING   AND   FLEXIBLE    CONDITIONS 

To  use  modelling  compound  successfully,  one  must  understand  what 
kind  to  use  and  the  conditions  of  its  use. 

When  Perfection  Modelling  compound  is  heated  in  water  to  between 

*This  article  began  in  the  January,  1916,  number. 


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140  THE  DENTAL  DIGEST 

i6o  and  170  degrees,  it  will  conform  to  either  soft  or  hard  tissue  with 
slight  pressure,  and  will  not  be  hot  enough  to  cause  discomfort. 

This  makes  it  possible  to  insert  into  the  mouth  when  itis  at  a  flowing 
consistency,  and  permits  the  muscles  to  trim  the  margins  of  the  denture 
without  straining  the  muscles.  Pressure  must  not  be  applied  to  the 
compound  till  it  has  passed  from  this  flowing  state  into  what  I  call  **the 
flexible  state"  when  it  can  be  bent  without  distorting  the  outline  form  of 


'A  satisfactory  water  heating  apparatus 

the  margins.  This  is  a  very  important  point  in  taking  impressions  of 
practically  all  uppers  and  many  lowers. 

Most  compounds  contain  too  much  gum;  and  as  a  result  do  not  reach 
the  flowing  state  until  heated  above  a  temperature  suitable  for  use  in  the 
mouth.    They  become  tough  and  stringy  at  lower  temperatures. 

This  toughness  has  a  tendency  to  improperly  displace  tissue  and  may 
prevent  a  satisfactory  impression  of  soft  ridges  and  the  buccal  and 
labial  attachments  of  the  upper  and  lower  jaws  are  easily  displaced. 

MOVABLE  SOFT  TISSUE  ON  THE  BUCCAL  AND  LABL\L  BORDER 

Surrounding  the  base  of  each  muscular  attachment  to  the  ridge  is 
movable  soft  tissue  on  which  pressure  can  be  brought  to  bear  in  such  way 
as  to  aid  in  the  retention  of  a  denture  and  increase  the  comfort  of  the 
patient  in  masticating. 


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CLOSfiD  MOOta  IM»R£SSl6lfS  141 

In  the  average  mouth,  this  movable  soft  tissue  covers  an  area  varying 
from  J  to  J  of  an  inch  wide  over  the  buccal  and  labial  border,  and  gener- 
ally comes  down  to  within  J  of  an  inch  or  less  of  what  may  be  called  the 
occlusal  surface  of  the  ridge. 

The  form  of  this  soft  tissue  is  readily  changed  by  the  movement  of 
the  muscles  in  passing  from  their  rear  to  their  forward  position. 

Dentures  which  are  to  be  permanently  successful  must  be  trimmed  by 
the  muscles  in  passing  from  their  rear  position  to  their  forward  position 
while  the  compound  is  in  a  flowing  state.  The  compound  must  then 
be  permitted  to  partially  set,  so  that  it  will  pass  from  the  flowing  state 
to  the  flexible  state.  Finger  pressure  can  be  then  exerted  without  caus- 
ing the  compound  to  flow.  By  means  of  this  flnger  pressure,  the  com- 
pound can  be  brought  to  bear  on  the  movable  soft  tissue  without  dis- 
placing the  muscular  attachments  or  compressing  them  in  a  distended 
position.  In  the  average  case,  one  minute  should  elapse  after  the  muscle 
trimming  before  finger  pressure  should  be  brought  to  bear  over  the  buccal 
and  labial  border. 

If  finger  pressure  is  brought  to  bear  when  compound  is  in  a  flowing 
state,  it  will  force  the  compound  upward  and  so  change  the  form  of  the 
margin  that  the  bearing  will  be  on  the  muscle  too  far  from  its  point  of 
attachment  to  the  ridge,  and  will  pull  or  improperly  displace  the  movable 
soft  tissue.  The  muscular  attachment  will  respond  to  this  pressure  and 
will  release  the  pull  on  the  movable  soft  tissue;  as  a  result  the  plate  will 
cease  to  be  in  contact  with  the  soft  tissue  and  the  muscle  will  then  move 
back  and  forth  beneath  the  edge  and  will  displace  the  denture. 

PRESSURE  ON  THE  MOVABLE  SOFT  TISSUE  SURROUNDING  THE  BASE  OF  THE 
MUSCULAR  ATTACHMENT  IS   IMPORTANT 

If  an  impression  is  taken  with  the  mouth  closed  and  pressure  is 
brought  to  bear  on  the  movable  soft  tissue  that  surrounds  the  attachment 
of  the  muscle  to  the  ridge  (less  than  yV  oi  an  inch  on  the  muscle  itself,) 
it  will  not  materially  interfere  with  the  free  movement  of  the  muscle 
When  the  mouth  is  opened,  there  will  be  a  pull  on  the  movable  soft  tissue 
by  the  muscle  that  will  cause  it  to  seal  the  edge  more  firmly,  so  that  the 
wider  the  mouth  is  opened,  the  more  firmly  the  joint  with  the  plate  will 
be  sealed  by  the  tissue. 

Inasmuch  as  the  mouth  is  closed  or  within  one  quarter  of  an  inch  of 
being  so  without  biting  pressure  being  applied  75  per  cent,  or  more  of  the 
time,  the  soft  tissue  is  under  light  pressure  three-quarters  of  the  time 
and  under  heavy  pressure  when  masticating,  say  one  quarter  of  the 
time. 

Movable  soft  tissue  will  sustain  a  considerable  pressure  without  the 


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142  THB  DENTAL  DIGEST 

circulation  being  affected  and  will  form  a  contact  with  the  plate  at  all 
times,  which  is  of  great  benefit  to  the  patient. 

The  amount  of  pressure  should  be  sufficient  to  embed  the  buccal  and 
labial  border  of  the  impression  into  the  soft  tissue.  When  such  pressure 
is  being  exerted  during  the  finishing  of  the  impression  the  thickness  of  the 
compound  and  the  amount  of  resistance  offered  by  the  compound  must  be 
considered;  by  referring  to  illustrations  you  will  note  the  different  for- 
mation which  can  be  given  to  the  compound,  in  the  same  mouth.  The 
illustrations  show  different  thicknesses  of  compound  overlaying  the 
buccal  surface  of  the  ridge  in  the  cuspid  region,  where  the  greatest 
change  in  the  shape  of  the  compound  is  possible. 

A  simple  experiment  to  learn  what  pressure  may  be  applied,  is  to  warm 
a  small  piece  of  compound  about  i  of  an  inch  thick,  and  wait  until  it 
has  passed  into  the  flexible  state.    Then  hold  it  between  the  tip  of  the 


No.  I  No.  2  No.  3 

Modifications  of  the  form  of  an  impression  by  pressure.    Three  impressions  from  one  mouth 

No.  I.  Illustrates  muscle  trimmed  impression  with  no  pressure  over  buccal  border. 

No.  2.  Muscle  trimmed  with  thicker  margin  but  pressure  exerted  over  the  buccal  bor- 
der when  the  mouth  was  closed  and  under  biting  pressure.  Modelling  compound  was  at 
the  proper  consistency  and  represents  the  necessary  contour  for  finished  denture. 

No.  3.  Muscle  trimmed.  Pressure  was  applied  when  compound  was  too  soft.  The 
rim  was  forced  higher  than  is  desired  in  the  denture.  The  rim  is  flared  outward  by  the 
improperly  displaced  muscular  attachments 

thumb  and  the  index  finger,  and  by  using  the  index  finger  of  the  other 
hand  note  how  much  pressure  is  necessary  to  embed  the  compound 
slightly  into  the  soft  tissue. 

TO  AVOID  TEMPORARY  RESULTS 

If  excess  pressure  is  brought  to  bear  on  this  tissue,  it  will  often  produce 
a  plate  that  will  be  exceedingly  tight  to  start  with;  but  in  a  short  time  the 
tissue  will  respond,  and  the  patient  will  experience  a  looseness  of  the 
denture  without  it  necessarily  dropping  from  place.  This,  in  some  cases, 
will  cause  a  loss  of  confidence,  and  the  psychological  effect  is  such  that  the 
patient  will  be  dissatisfied  with  what  would  otherwise  have  been  a  very 
satisfactory  denture.  In  many  cases  where  the  distortion  has  been  very 
great,  the  plate  will  be  absolutely  useless. 

It  is  far  better  to  have  too  light  a  pressure  than  too  heavy.  The 
former  will  improve  in  fit  within  a  day,  while  the  latter  will  become  less 
firm  in  two  or  three  weeks. 

{To  be  continued) 


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TECHNIC  FOR  MAKING  GOLD  CROWNS  143 


TECHNIC  FOR  MAKING   GOLD   CROWNS  FOR  POSTERIOR 
TEETH  IN  MOUTH  WHERE  THE  BITE  IS  VERY  CLOSE 

By  Raymond  S.  Scovil,  D.D.S.,  Johnstown,  N.  Y. 

After  the  proper  grinding  of  a  tooth  for  a  gold  crown,  there  are  three 
things  that  I  take  into  consideration  in  making  the  crown. 

(i)  The  relation  of  the  occlusal  surface  of  the  crown  to  the  tooth 
that  strikes  it  in  masticating. 

(2)  The  technic  and  shape  of  the  crown  to  the  other  teeth. 

(3)  The  kind  of  a  crown  that  is  easiest  made  and  still  keep  the  first 
two  principles  that  I  have  mentioned. 

In  a  mouth  where  the  teeth  come  together  naturally  and  the  bite 
is  light  I  make  a  seamless  gold  crown,  the  occlusal  surface  of  which  can 
easily  be  carved  to  articulate  perfectly  with  the  contending  teeth.  In 
cases  where  the  bite  was  very  heavy  and  the  teeth  all  worn  smooth  by 
mastication  I  usually  made  the  two-piece  cap  and  band  crown.  Now 
after  considerable  experimenting  I  have  been  able  to  make  a  cast  gold 
crown  that  has  the  appearance  of  a  natural  tooth.  When  I  say  appear- 
ance, I  mean  the  occlusal  surface  of  the  crown  has  the  same  striking  effects 
as  a  natural  tooth,  the  carving  of  it  is  the  same  as  natural  teeth  and  the 
labial  and  the  lingual  sides  are  the  same.  In  this  crown  after  it  has  been 
poKshed,  there  can  be  seen  no  dividing  line  between  the  cap  and  the  band, 
and  it  has  all  the  graceful  lines  and  curves  of  a  natural  tooth  that  a  two 
piece  crown  cannot  always  have. 

Recently  a  man  came  into  my  office  to  have  work  done.  After  exam- 
ining his  teeth  I  found  that  he  had  a  lower  second  molar  to  be  crowned. 
The  bite  was  very  heavy  and  all  his  lower  posterior  teeth  were  worn 
smooth  as  a  result  of  inveterate  plug  tobacco  chewing.  To  this  case  I 
made  the  cast  gold  crown  which  took  in  actual  time  not  including  hard- 
ening of  plaster,  about  one-half  an  hour. 

When  this  crown  was  finished  it  could  have  stood  a  test  against  any 
seamless  or  two-piece  crown  in  appearances  or  masticating  properties. 

In  making  this  kind  of  a  crown  I  use  the  following  method.  After 
the  impression  has  been  taken  and  the  model  has  been  mounted  upon 
the  articulator,  I  take  the  dentimeter  and  take  a  wire  measurement  of  the 
tooth  while  the  patient  is  in  the  office  and  then  I  compare  it  with  the 
tooth  on  the  plaster  model  which  I  had  just  mounted.  If  they  agree  I 
take  a  fine  pointed  instrument  and  carve  the  gum  margin  in  the  usual 
way,  but  a  small  fraction  of  an  inch  deeper.  I  then  make  a  gold  band  to 
fit  the  tooth  snugly  paying  careful  attention  to  allow  the  ends  of  the 
bands  to  overlap  each  other  when  soldering,  and  also  to  have  the  band  a 


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144  THB  DBIITAL  DIOBST 

small  fraction  of  an  inch  higher  than  the  top  of  the  ground  tooth.  I  then 
with  the  pliers  contour  the  band  paying  good  attention  to  appearance  to 
lines  on  the  labial  and  lingual  sides. 

I  then  take  some  inlay  wax  and  soften  it  and  place  it  gently  on  the 
top  of  the  tooth  with  band  around  and  close  the  bite  together  giving  very 
careful  attention  to  the  sliding  bite  as  well  as  the  natural  bite,  straight  up 
and  down.  I  then  separate  the  bite  and  begin  to  carve  the  wax.  In 
trimming  the  wax  at  the  top  edge,  extend  the  wax  over  the  band  a  little. 
If  you  find  that  the  band  has  not  been  properly  contoured  you  can 


n  db 


Illus.  No.  I  Ulus.  No.  2 

remedy  this  by  building  it  out  with  wax.  Another  important  thing  to 
remember  is  to  allow  a  small  scale  of  wax  to  extend  over  the  seam,  where 
the  band  was  soldered,  on  the  outride  of  the  band.  Often  in  casting,  the 
solder  at  the  joint  will  run  and  the  joint  will  be  very  weak.  Now  if  the 
solder  should  run  it  would  be  resoldered  in  casting. 

After  the  wax  has  been  properly  carved  and  shaped  remove  the  band 
with  the  wax  together  and  cut  all  excess  wax  from  the  inside  of  the  band. 

The  next  and  most  important  step  is  the  investing  of  this  whole 
construction.  Remember  the  band  and  the  wax  top  are  invested  to- 
gether. In  investing  this  construction  do  not  insert  the  sprue  wire  in 
the  top  of  the  occlusal  surface  (see  Illus.  No.  i).  There  is  a  possibility 
in  casting  that  solder  will  run  on  the  outside  of  the  band  where  it  is  not 
needed,  also  a  possibility  of  solder  running  on  the  inside  of  the  band 
making  it  almost  impossible  to  put  on  the  tooth  in  the  mouth  without  a 
lot  of  grinding. 

Insert  the  sprue  wire  between  the  gold  band  into  the  back  of  the  wax 
crisp  (see  Illus.  No.  2)  and  when  the  gold  and  solder  are  run  into  casting 
it  will  only  run  where  wax  was  on  the  band.  After  this  precaution  in- 
vest in  the  usual  manner  and  after  investment  is  sufficiently  hard  and  dry 
place  in  heater  and  burn  out  wax.  Take  22  karat  gold  and  an  equal 
amount  of  solder  and  melt  over  the  sprue  hole  and  when  gold  is  the  color 
of  white  heat  cast  in  usual  manner.  The  casting  apparatus  that  I  use  is 
nothing  more  than  a  two  inch  gas  pipe  filled  with  wet  asbestos;  with  this 
I  force  the  gold  into  the  sprue  hole  in  the  casting  ring.  Any  ordinary 
casting  apparatus  will  do. 


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RUGAE  145 

After  the  casting  is  cool  and  the  cast  taken  out,  cut  out  sprue  and 
ix>lish.  After  the  crown  is  polished  you  will  wonder  where  the  dividing 
line  is.  When  you  put  the  crown  in  the  mouth  you  will  find  that  it  is  the 
best  fiUingy  and  the  best  looking  and  has  the  best  occlusal  surface  of  any 
crown  you  have  made.  You  will  also  find  out  later  that  it  is  the  best 
wearing  crown  you  have  ever  put  in.  This  method  of  making  of  cast  gold 
holds  true  of  all  posterior  teeth. 


RUGAE 
By  Victor  Lay,  D.D.S.,  Buffalo,  N.  Y. 

It  seems  that  rugae  are  not  only  desirable,  but  quite  necessary.  It  is 
said  that  the  tip  of  the  tongue  is  the  most  sensitive  spot  in  the  human 
anatomy.  If  this  is  true,  then  the  tongue  will  aid  speech  and  mastication, 
and  will  feel  more  at  ease,  when  it  is  in  contact  with  a  close  reproduction 
of  the  Almighty-designed  surface. 

To  satisfy  yourself,  try  some  experiments  on  your  own  palatal  surface, 
using  a  smooth  wax  base  Dlate,  first — then  add  some  wax  rugae  and  note 
the  difference. 

To  be  of  any  service,  the  rugae  must  be  well  forward,  beginning  with 
a  central  ruga  just  behind  the  central  teeth,  and  running  distally  in  the 
median  line.  From  this  the  other  rugae  radiate,  and  should  imitate  the 
characteristics  of  the  case  at  hand. 

To  produce  this  effect,  the  trial  plate  (teeth  set  up)  is  removed  from  the 
model,  and  the  rugae  traced  onto  the  palatal  surface  of  the  plate  with  a 
hot  wax  spatula,  using  one  of  the  pink  waxes  which  cools  to  the  desired 
hardness.  First  produce  the  central  ridge,  then  imitate  the  character- 
istics appearing  on  the  model.  The  proper  sharpness  and  accuracy  is 
obtained  by  trimming  the  wax  with  a  sharp  knife.  Smooth  by  waving 
over  the  flame.  Thin  sheet  tin  is  now  burnished  over  the  surface,  the 
plate  being  on  the  model.  A  rubber  eraser  makes  a  good  burnisher. 
Turn  up  several  lugs  on  the  edge  of  the  tin  to  engage  the  plaster  when 
the  upper  half  of  the  flask  is  filled.  This  is  not  especially  new,  but  may 
be  of  some  assistance  to  someone. 


AN  AID  IN  MAKING  LARGE  PLUMPERS 

In  making  large  plumpers,  a  piece  of  old  vulcanite  plate  is  shaped 
up  approximately  to  fill  the  space  in  the  investment  and  wrapped  in  a 
hot  water  sheet.  This  will  prevent  porosity.— F.  H.  B.,  The  Dental 
Cosmos. 


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146  THE  DENTAL  DIGEST 

SUGAR  AND  ITS  EFFECT  UPON  THE  TEETH 

By  John  S.  Engs,  D.D.S.,  Oakland,  Cal. 

As  the  things  with  which  we  are  in  daily  contact  are  sometimes  passed 
unobserved,  so  precautions,  which  if  taken  in  time  would  often  prevent 
disease,  are  disregarded  because  of  their  very  commonplaceness  and  sim- 
plicity. **But  it  is  the  little  things  in  life  that  count,"  and  as  stick  upon 
stick  and  stone  upon  stone  great  structures  rise,  so  our  bodies  grow,  cell 
by  cell  being  formed  from  food  taken  by  the  growing  organism. 

Like  many  other  destructive  processes  which  are  probably  acceler- 
ated by  the  strenuous  life  of  to-day,  caries  of  teeth,  or  tooth  decay,  is  on 
the  increase.  So  universal  is  its  presence,  that  an  English  doctor,  James 
Wheatley,  said  that  measures  to  check  its  advance  are  as  much  needed 
as  are  measures  to  check  the  spread  of  tuberculosis.  He  said  also,  that 
consumption  of  candies  and  sweets  is  greater  than  at  any  time  in  history, 
a  state  of  things  which  he  disapproves  of  strongly.  Another  authority, 
J.  Hopewell  Smith  of  London,  said,  parents  should  not  allow  children  to 
indulge  in  sweetmeats;  if  they  must  eat  them,  then  only  those  made  of 
pure  sugars  free  from  adulterations  should  be  employed;  eating  them  at, 
not  between  meals.  (I  think  if  I  were  to  advise  as  to  the  kind  of  sugar 
to  use  in  making  candy  for  children,  I  would  not  say  "pure  sugar,"  be- 
cause by  that  is  understood  refined  sugar,  but  rather  use  crude  sugar  or 
cane  syrup,  for  it  contains  all  the  food  element  of  the  juice  of  the  sugar 
cane,  which  has  been  found  to  be  capable  of  furnishing  body  building 
material  and  sufficient  energy  to  enable  the  user  to  subsist  on  it  entirely, 
during  long  periods  when  engaged  at  hard  manual  labor,  to  the  exclusion 
of  all  other  food  materials.  Such  sugar  will  make  "panoche"  a  favorite 
mixture  with  school  girls  and  also  drawn  candy  with  which  we  were  all 
more  or  less  familiar  some  years  ago.)  He  expressed  it  as  his  opinion, 
that  the  confectionery  factories  and  the  wares  of  street  venders  should 
be  placed  under  State  control.  England  leads  the  world  in  the  consump- 
tion of  sugar  per  capita;  the  United  States  comes  next.  Does  not  that 
offer  us  food  for  thought? 

SUGAR 

When  used  in  reasonable  amounts  sugar  is  one  of  our  most  valuable 
food  products.  It  furnishes  both  heat  for  the  body  and  working  power 
for  the  muscles.  Practical  demonstration  has  shown  that  it  also  possesses 
stimulating  properties  which  enable  us  to  tide  over  periods  when  without 
it,  the  body  would  succumb  to  fatigue.  But  used  in  excess  as  it  is  to-day 
all  over  the  world,  particularly  in  England  and  the  United  States,  it  is 


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SUGAR  AND  ITS  EFFECT  UPON  THE  TEETH  147 

beKeved  to  be  detrimental  to  our  health  and  destructive  to  the  osseous 
tissues  of  the  body. 

Most  of  the  bad  effects  of  sugar  are  due  to  its  use  in  greater  amounts 
than  3  to  4  ounces  per  day.  It  is  not  locally  harmful  to  the  teeth,  but  is 
injurious  to  them  through  its  action  upon  the  digestive  system  and  meta- 
bolism. Like  starch,  sugar  is  fattening.  When  consumed  in  large  quan- 
tities the  excess  is  transformed  into  fat  and  stored  away  as  reserve 
material.  While  a  very  active  child  may  bum  up  a  large  amount  of 
carbohydrates  to  supply  energy  for  his  play,  a  less  active  one  would  soon 
feel  the  effect  of  overindulgence  in  sugar  and  sweetmeats,  through  indi- 
gestion and  an  overloading  of  the  excretory  organs. 

The  chief  tissues  concerned  in  the  elimination  of  waste  material  from 
the  body  are  the  skin,  lungs  and  air  passages  (including  the  mouth  and 
nose),  the  kidneys,  liver  and  intestines.  Interference  with  the  elimin- 
ative  powers  of  the  three  latter  is  especially  apt  to  throw  extra  work  on 
the  skin,  lungs  and  air  passages.  This  gives  the  sour  wine  odor  in  the 
breath  of  diabetics.  The  peculiar  foul  odor  of  the  breath  and  skin  in  foe- 
cal  intoxication  indicates  that  the  mucous  membrane  of  the  mouth,  throat, 
nose  and  gums  is  doing  the  elimination  work  that  should  have  been  done 
by  the  intestines.  The  failure  of  the  kidneys  to  do  their  proper  elimin- 
atory  work  is  apt  to  find  expression  in  the  skin,  lungs,  nose,  mouth  and 
gums.  It  is  a  matter  of  common  observation  that  sugar  and  sweetened 
food  is  apt  to  ferment  in  the  stomach  and  intestines.  There  are  so  many 
illustrations  of  the  refusal  of  the  system  to  utilize  large  amounts  of  sugar 
that  we  should  take  warning  from  them.  They  show  that  the  consump- 
tion of  candy  can  easily  be  carried  too  far. 

FERMENTATION 

Sugar,  by  which  is  understood  the  sugar  of  commerce,  cane  sugar,  is 
one  of  the  carbohydrates  and  like  starch,  is  transformable  into  invert- 
sugar  or  glucose  which  is  fermentable.  It  is  open  to  three  different  fer- 
mentations; the  alcoholic,  the  lactic  acid  and  the  acetic  acid.  The  sec- 
ond or  lactic  add  is  at  present  of  greatest  interest  to  the  dentist,  because 
to  it  is  attributed  the  destruction  of  tooth  substance  that  occurs  in  dental 
caries.  How  far  this  is  true  we  do  not  at  present  know.  Some  still  think 
that  decay  is  entirely  due  to  the  action  of  lactic  acid;  while  to  others — 
myself  included — conditions  in  decayed  teeth  are  continually  presenting 
themselves  that  cannot  be  explained  in  a  satisfactory  manner  by  the 
theory  of  Miller.  It  is  for  that  reason  that  I  take  the  liberty  to  present 
this  paper  in  an  effort  to  show  why  it  is  believed  that  an  excessive  con- 
sumption of  sugar  may  bring  on,  or  serve  as  a  contributory  cause,  of 
caries,  in  an  entirely  different  manner  from  that  which  we  have  been 


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148  THB  DENTAL  DIGEST 

taught;  and  that  its  action  may  be  from  the  inside  and  not  as  we  are 
generaUy  led  to  believe,  entirely  from  the  outside,  beginning  at  the  enamel. 

ACTION   UPON  TEETH 

Explanations  to  account  for  the  baneful  effect  of  excessive  sugar  eating 
upon  the  teeth  usually  tend  to  show  that  ultimately,  the  oral  secretion  is 
modified  or  that  substances  develop  in  it  that  attack  first  the  enamel  and 
then  the  dentin. 

A  more  recent  hypothesis  has  been  offered,  however,  based  on  the  belief 
that  faults  of  nutrition,  or  faulty  metabolism  is  at  the  root  of  the  evil; 
and  that  absence  of  lime  in  sufficient  quantity  in  our  daily  food  or  exces- 
sive elimination  of  the  same,  from  the  body  is  the  cause.  This  condition 
is  believed  to  be  due  to  the  action  of  sugar,  through  its  affinity  for  lime, 
or  to  a  general  acidosis  of  the  system  that  may  result  from  many  causes, 
one  of  which  is  the  excessive  use  of  sugar,  particularly  amongst  growing 
children. 
I2TH  &  Broadway. 

(To  be  cofUimied.) 


THE  SEPTIC  WHEEL-BRUSH 
By  R.  R.  C. 

Dr.  Feldman's  indictment  of  the  tooth-brush  may  be  somewhat  over- 
drawn, but  if  it  is,  it  is  on  the  safe  side.  He  deserves  credit  for  provoking 
discussion  of  that  subject. 

There  is  another  brush  that  should  be  indicted  and  its  use  stopped,  and 
that  is  the  engine  wheel-brush  used  by  some  dentists  for  the  purpose  of 
cleaning  burs  and  broaches. 

This  rapidly  revolving  brush  cleans  (?)  from  the  burs  and  broaches 
the  filthy,  septic  debris  that  accumulates  on  them  in  their  use  and  thor- 
oughly distributes  it  in  the  air  of  the  office  breathed  by  the  dentist  and 
his  patients. 

A  better  way  is  to  sterilize  burs  that  are  worth  it  and  use  broaches  in 
but  one  case.     Broaches  are  not  expensive. 

Whether  a  dentist  uses  this  method  or  the  brush-wheel  is  an  indication 
of  his  inteUigence. 


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A  BETTER  GOLD  INLAY  149 

A  BETTER  GOLD  INLAY 
By  W.  Goddard  Sherman  D.D.S.,  Providence,  R.  I. 

There  are  numerous  methods  of  constructing  gold  inlays,  each  per- 
haps possessing  one  or  more  points  of  superiority  over  another  and  yet  by 
reason  of  some  fault  during  the  process,  failing  to  produce  a  restoration 
which  is  perfect  in  every  respect,  especially  at  the  margins. 

I  consider  the  margins  of  gold  inlays  or  any  other  filling  material  the 
most  important  factor  in  effecting  a  successful  operation. 

Some  of  the  contributory  causes  of  so-called  failures,  I  believe  from  ob- 
servance, are: —  inaccuracy  of  investment  materials  by  expansion  or  con- 
traction; amount  and  fineness  of  gold  used  in  proportion  to  the  size  of 
the  inlay;  faulty  impressions  of  cavities  for  indirect  method  and  the 
peculiar  manifestations  of  various  kinds  of  inlay  wax  used  for  the  direct 
method. 

K  the  margins  of  the  average  gold  fillings  and  inlays — especially  cast 
inlays — ^be  examined  under  a  strong  magnif  jdng  glass  or  by  the  use  of  a 
delicate  explorer,  a  break  in  the  continuity  may  be  detected. 

I  believe  the  most  accurate  results  in  casting  are  obtained  by  the  in- 
direct method,  using  amalgam  dies. 

However,  by  the  following  method,  which  I  have  employed  for  some 
time,  I  find  it  possible  to  construct  inlays  surpassing  those  resulting  from 
any  other  method,  and  also  excelling  gold  fillings  without  endangering  the 
enamel  margins  which  spell  " Success ''  or  "Failure." 

The  following  is  the  method  and  technic  I  have  formulated. 

The  cavity  should  be  prepared  as  per  rule  for  inlays  with  walls  diverg- 
ing slightly  more  than  for  cast  inlays.  All  enamel  margins  should  be 
left  sharp  and  well  defined. 

The  cavity  is  now  to  be  moistened  or  oiled  and  an  impression  taken 
with  warmed  modeling  compound.  The  compound  is  then  to  be  chilled 
and  carefully  removed  and  examined  to  see  if  all  margins  are  clearly 
recorded  in  the  impression.  A  bite  in  wax  is  then  taken  and  patient 
dismissed. 

A  die  of  amalgam  is  made  from  the  impression  and  by  the  aid  of  wax 
bite  moxmted  on  an  anatomical  articulator.  From  the  amalgam  die  is 
taken  any  number  of  impressions  in  modeling  compound  until  accuracy 
is  assured.  A  cement  die  is  then  made  and  after  being  separated  from 
the  impression  is  invested  in  either  modeling  compound  or  plaster  to 
strengthen  the  mass  and  protect  any  frail  walls. 

Gold  foil  is  now  to  be  packed  into  the  cavity  by  hand  pressure  only 
and  tooth  restored  to  desired  contour  and  occlusion. 


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150  THE  DENTAL  DIGEST 

Filling  may  be  removed  from  cement  die  and  tried-in  in  amalgam  die 
from  time  to  time  to  govern  size,  contour,  etc. 

Great  care  is  to  be  exercised  during  packing  against  margins  and  quite 
a  surplus  should  be  used.  A  flat  gold-burnisher  is  then  to  be  used  to  aid 
in  condensing  the  entire  surface,  following  the  rule  of  burnishing  toward 
and  not  away  from  margins. 

When  filling  is  completed  the  cement  die  with  filling  in  place  is  thor- 
oughly dried  out  and  then  heated  in  a  Bunsen  flame  until  it  assumes  a 
cherry-red  color. 

The  inlay  when  cool  is  placed  in  amalgam  die  properly  seated  and 
given  final  trimming,  shaping  and  polishing  except  at  margins  where  a 
fine  feather  edge  is  to  be  left.  Inlay  is  now  ready  to  be  inserted  for 
try-in  in  the  mouth  and  if  found  correct  (it  will  be  correct  if  preparation 
of  cavity  and  impression  were  correct)  it  is  removed  and  preparations 
made  for  cementing.  Depending  upon  the  case,  undercuts  may  or  may 
not  be  necessary. 

A  thin,  smooth  mix  of  a  good  inlay  cement  is  used  after  sterilizing  and 
drying  cavity  and  inlay  is  inserted  to  place  with  considerable  hand  pres- 
sure. Do  not  use  a  malleL  While  the  cement  is  still  soft  burnish  the 
margins.  The  final  finish  may  be  given  at  this  or  a  subsequent  sitting. 
Use  only  very  fine  abrasives  and  avoid  strips  and  discs  as  much  as  possi- 
ble. The  burnisher  properly  used  for  final  finishing  is  the  ideal  instru- 
ment. 

The  result  will  be  a  gold  inlay  with  margins  nearer  perfect  than  I 
believe  possible  to  obtain  with  any  other  filling  material  or  process.  The 
gold  is  harder  than  a  well  condensed  gold  filling,  yet  soft  enough  to  be 
easily  manipulated  at  margins  without  evil  results. 

Of  the  advantages  of  this  method  it  might  be  stated  that  for  large  res- 
torations it  is  much  easier  for  the  patient  and  less  tiresome  for  the  oper- 
ator with  the  added  advantage  that  the  inlay  is  practically  finished  when 
inserted,  requiring  only  a  final  burnishing  of  margins. 

By  the  use  of  this  method  where  large  gold  filUngs  are  indicated,  more 
satisfactory  operations  will  result  and  much  time  and  energy  will  be 
saved. 

171  Westminster  St. 


A  Laboratory  Hint. — ^When  working  with  wax  in  the  laboratory, 
use  a  large  common  school  slate  for  a  bench  cover.  It  will  catch  all 
pieces  and  drops  of  melted  wax  and  when  removed  leaves  the  bench 
clean  and  ready  for  the  next  work.  Wax  spots  on  a  bench  may  be  very 
annoying  when  gold  work  is  being  done. — Pacific  Dental  Gazette. 


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WRONGFUL  DISCHARGE  OF  DENTIST  151 

WRONGFUL  DISCHARGE  OF  DENTIST 

(Georgia)  One  who  is  employed  as  a  dentist  by  a  dental  association 
or  company,  and  who  is  discharged,  has  the  right  of  electing  either  of  three 
remedies:  (i)  He  may  bring  an  immediate  action  for  any  special  injury 
received  from  the  discharge;  (2)  He  may  wait  until  the  expiration  of  the 
term  for  which  he  was  employed,  and  sue  for  the  entire  amount  due  him 
under  the  contract;  or  (3)  He  may  treat  the  contract  as  rescinded  and 
seek  to  recover  upon  quantum  meruit  the  value  of  the  services  actually 
performed.  Reasonably  construed,  the  present  suit  is  an  action  to 
recover  the  value  of  the  plaintiff's  services  for  the  entire  term  fixed  by 
the  contract,  though  it  was  brought  before  the  expiration  of  the  term; 
and  a  finding  for  the  plaintiff  was  not  supported  by  the  evidence.  Proof 
that  the  plaintiff  was  willing  to  perform  the  services  for  the  unexpired 
j>art  of  the  term,  and  that  the  value  of  the  services  as  fixed  by  the  contract 
amounted  to  $137.30  would  not  authorize  a  recovery  of  that  amount, 
where  it  appeared  that  the  suit  was  brought  prior  to  the  expiration  of  the 
term.     (Continental  Ass'n  v.  Lee,  85  S.  E.  790.) 

LIABILITY  OF  HOSPITAL  FOR  NEGLIGENCE  IN  CARING  FOR  PATIENTS 

{California)  Though  the  case  of  Wilbur  v.  Emergency  Hospital 
decided  by  the  District  Court  of  Appeal  of  California  turned  on  the 
sufficiency  of  the  evidence,  and  makes  no  final  determination  of  any  very 
important  legal  questions,  the  facts  are  quite  interesting,  and  under  other 
drciunstances  might  well  involve  matters  of  serious  legal  import.  The 
action  was  instituted  for  recovery  of  damages  for  the  death  of  plaintiff's 
18  year  old  son,  who,  at  the  time  of  his  decease,  was  a  patient  in  defen- 
dant's hospital.  He  was  suffering  from  an  infected  jaw  bone  and  during 
the  first  week  of  his  treatment  was  under  the  care  of  a  special  nurse,  who 
devoted  all  her  time  to  attending  him.  She  prepared  a  solution  of  bichlor- 
ide of  mercury  for  use  in  disinfecting  the  thermometer  with  which  she 
took  her  patient's  temperature,  and  on  leaving,  at  the  end  of  a  week, 
when  it  was  thought  that  her  services  were  no  longer  necessary,  she  left 
the  mixture  on  a  chiffonier  in  the  patient's  room.  Sometime  later,  one 
of  the  hospital  nurses  entered  the  room  and  saw  young  Wilbur  just  getting 
back  into  bed,  and  was  told  by  him  that  he  had  drunk  the  contents  of  the 
glass  on  the  chiffonier.  Antidotes  were  administered,  and  the  young 
man,  on  being  q^estioned,  stated  that  he  had  no  such  feelings  or  symp- 
toms as  usually  attend  bichloride  of  mercury  poisoning.  He  died  about 
fifteen  hours  later.  The  court  holds  that  the  evidence  is  insufficient  to 
show  that  his  death  resulted  from  swallowing  the  contents  of  the  glass, 
and  the  circumstances  and  symptoms  were  just  as  consistent  with  the 


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152  THE  DENTAL  DIGEST 

theory  that  the  liquid  might  have  been  thrown  out  of  the  window  as 
with  the  drinking  of  it  by  deceased,  and  that  his  statements  to  the  nurse 
were  inadmissible  as  evidence  that  he  actually  drank  the  poison.  (Wil- 
bur V.  Emergency  Hospital,  154  Pac.  155.) 

MINOR  RESPONSIBLE  FOR  PROFESSIONAL  SERVICES 

(Louisiana)  Where  a  minor,  who  has  reached  a  stage  of  maturity 
calculated  to  deceive  a  person  of  ordinary  prudence,  deceives  a  dentist 
as  to  his  age,  and  asserts  that  he  is  of  full  age,  and  induces  the  dentist 
to  render  him  professional  services,  and  accepts  the  benefits  thereof,  he 
cannot  deny  that  he  was  of  full  age,  and  escape  the  obligation  of  the 
contract.     (Lake  v.  Perry,  49  So.  569.) 

CAN  A  SERVANT  BE  CONSIDERED  IN  THE  EMPLOY  OF  HIS  MASTER  WHILE 

TAKING  A  HOLIDAY? 

(California)  A  wealthy  gentleman  by  the  name  of  E.  W.  Cowell  died 
in  March,  191 1,  leaving  a  will  which  gave  to  all  of  the  employees  of  a 
certain  dental  supply  company  in  which  he  was  interested,  and  who  had 
been  in  said  employ  for  twenty  years,  the  sum  of  $1,000  each,  "and  to  all 
who  have  worked  over  ten  years  the  sum  of  $500  each;  ...  In  all 
cases  these  dates  are  as  of  January  i,  19 11."  Frank  Tralago,  claiming 
to  be  entitled  to  a  portion  under  this  provision,  which  was  opposed  partly 
on  the  ground  that  petitioner  was  not  engaged  in  the  employment  of  the 
designated  company  on  January  i,  191 1.  It  was  conceded  that  this  was 
a  holiday,  and  petitioner  was  not  actually  at  work.  The  evidence  went 
to  show  that  he  had  been  paid  off  the  day  before,  and  did  not  again  return 
to  work  for  some  little  time  after  the  first  of  the  year.  The  Supreme 
Court  of  California  passing  on  this  question  in  In  re  CowelFs  Estate, 
adjudges  it  as  being  rather  too  technical  a  construction  of  the  will,  as 
testator  must  have  known  that  the  day  designated  was  a  holiday,  and 
could  hardly  have  meant  to  defeat  his  own  purpose  of  rewarding  faith- 
ful employees  by  insertion  of  a  condition  which  would  make  this  im- 
possible. Tralago  was  held  entitled  to  a  $500  share  of  testator's  property. 
(In  re  CoweD's  Estate,  149  Pac.  809.) 

SALE   OF  DENTAL  FIXTURES 

(Georgia)  Where,  in  a  contract  for  the  sale  of  dental  office  fixtures 
and  supplies  the  purchaser  agrees  to  make  a  partial  cash  payment  and 
give  notes  for  the  balance,  the  seller  to  retain  title  until  the  full  purchase 
money  is  paid,  tender  on  the  terms  of  the  buyer's  compliance  with  the 
contract  will  not  have  the  effect  of  transferring  the  title  to  the  purchaser. 
If  the  buyer  refuses  to  make  the  partial  payment  and  give  the  notes  as 


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A  NEW  METHOD  OF  CONSTRUCTING  ARTIFICIAL  DENTURES     153 

called  for  by  the  terms  of  sale,  or  to  accept  any  possession  or  control  of 
the  property,  no  title  passes  to  him,  and  the  seller's  remedy  is  not  for 
the  purchase  price  of  the  chattel,  but  for  the  breach  of  the  contract. 
(Bridges  &  Murphy  v.  McFarland,  85  S.  E.  856.) 


EXTRACT  FROM  "A  NEW  METHOD  OF  CONSTRUCTING 
ARTIFICIAL  DENTURES"* 

By  Doctor  J.  Allen,  1856 

It  may  be  interesting  to  dentists  to-day  to  read  what  a  prominent  dentist  pub- 
lished in  book  form,  something  over  a  half  a  century  ago,  for  distribution  to  the  pub- 
lic and  for  the  instruction  of  the  public  in  his  particular  line  of  work.  Dr.  Allen  must 
have  thought  that  the  public  knew  a  great  deal  about  anatomy,  because  he  does 
not  hesitate  to  use  technical  terms  freely,  either  for  the  purpose  of  instructing  them 
or  impressing  them  without  instructing. — EDrros. 

THE  FACE 

"Is  formed  of  diflferent  muscles,  which  give  it  shape  and  expression. 
These  muscles  rest  upon  the  teeth  and  alveolar  processes,  which  sustain 
them  in  their  proper  position. 

"When  the  teeth  are  lost,  and  a  consequent  absorption  of  the  alveolus 
takes  place,  the  muscles  fall  in,  or  become  sunken  in  a  greater  or  less 
degree,  according  to  the  temperament  of  the  person.  If  the  lymphatic 
predominates,  the  change  will  be  but  slight.  If  nervous  sanguine,  it  may 
be  very  great. 

"There  are  four  points  of  the  face  which  the  mere  insertion  of  teeth 
does  not  always  restore,  viz:  one  upon  each  side,  beneath  the  molar  or 
cheek  bone;  and  one  upon  each  side  of  the  base  of  the  nose,  in  a  line 
toward  the  front  portion  of  the  malar  bone. 

"The  muscles  situated  upon  the  sides  of  the  face,  and  which  rest 
upon  the  molar  or  back  teeth,  are  the  Zygomaticus  Major,  Masseter,  and 
Buccinator.    The  loss  of  the  above  teeth  cause  these  muscles  to  fall  in. 

"The  principle  muscles  which  form  the  front  portion  of  the  face 
and  lips  are  the  Zygomaticus  Minor,  Levator  labii  superioris  alaeque 
nasi  and  Orbicularis  oris. 

"These  rest  upon  the  front,  eye,  and  Bicuspid  teeth;,  which,  when 
lost,  allow  the  muscles  to  sink  in,  thereby  changing  the  form  and  expres- 
sion of  the  mouth. 

"The  insertion  of  the  front  teeth,  will,  in  a  great  measure  bring  out 
the  lips,  but  there  are  two  muscles  in  the  front  portion  of  the  face  which 
cannot,  in  many  cases,  be  thus  restored  to  their  original  position;  one 
♦Courtesy  of  C.  A.  Heller. 


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154  THE  DENTAL  DIGEST 

is  the  Zygomaticus  minor,  which  arises  from  the  front  part  of  the  malar 
bone,  and  is  inserted  into  the  upper  lip  above  the  angle  of  the  mouth. 
The  other  is  the  Levator  labii  superioris  alaeque  nasi,  which  arises  from 
the  nasal  process  and  from  the  edge  of  the  orbit  above  the  infra-orbital 
foramen.     It  is  inserted  into  the  ala  nasi  or  wing  of  the  nose  and  upp)er 

lip. 

"The  attachments  before  mentioned,  applied  to  these  four  points  of 
the  face,  beneath  the  muscles  just  described,  bring  out  that  narrow- 
ness and  sunken  expression  about  the  upper  lip,  and  cheeks,  to  the 
same  breadth  and  fulness  which  they  formerly  displayed,  thus 
restoring  the  original,  pleasing  and  natural  expression.  These  attach- 
ments for  restoring  the  form  of  the  face  were  first  constructed  by  the 
subscriber,  some  eight  years  since,  and  they  have  been  constantly  worn 
by  various  persons  with  ease  and  comfort  ever  since  that  period.  They 
were  first  formed  of  gold  plates  by  being  stamped  to  the  requisite  form, 
and  attached  to  the  main  plate  and  teeth.  The  plates  are  now  covered 
with  the  compound,  of  which  the  artificial  gum  is  formed,  and  which 
renders  the  denture,  when  thus  constructed,  far  more  perfect  than  the 
previous  mode. 

"The  perfection  to  which  this  style  of  work  has  been  brought  by  the 
Author,  has  induced  him  to  devote  his  exclusive  attention  to  the  con- 
struction of  full  and  partial  Sets  of  Teeth;  in  doing  which  he  pledges 
himself  to  carry  out  faithfully  the  principles  here  set  forth." 

J.  Allen, 
No.  30  Bond  Street,  New  York. 


Editor  Dental  Digest: 

My  little  daughter  is  two  and  a  half  years  old  and  has  only  10  teeth, 
4  upper  incisors  and  2  molars  and  only  the  two  lower  indsors  and  2 
molars.  She  has  not  been  sick,  but  is  nervous,  fidgety  and  will  not 
sleep  all  night.  She  was  just  16  months  old  before  she  had  a  tooth. 
I  can  see  where  the  unerupted  teeth  are,  but  am  at  a  loss  to  explain 
just  why  they  do  not  erupt.  Her  appetite  is  good  but  the  poor  "kid" 
cannot  properly  masticate  her  food. 

Now  what  can  be  done  to  help  these  teeth  erupt?  I  do  not  think  to 
lance  the  gimis  would  help,  owing  to  the  thickness  of  gum  tissue. 

Trusting  some  one  can  explain  about  the  delayed  eruption  of  the 
teeth  of  the  two  and  a  half  year  old  girl,  I  am. 

Fraternally  yours, 

M. 


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FOOD  FOR  DENTISTS  155 

FOOD  FOR  DENTISTS 

By  Watson  W.  Eldridge,  M.D.,  New  Rochelle,  N.  Y. 

The  author  of  this  paper  is  particularly  well  fitted  to  write  upon  ail- 
ments arising  in  the  alimentary  canal.  He  is  a  member  of  the  Gastro-en- 
terological  Clinic  of  New  York  University  and  Bellcvue  Medical  College, 
and  comes  into  contact  with  many  cases  of  systemic  depression  arising 
from  lowered  tone  and  impaired  function  in  the  intestines. 

He  has  prepared  this  paper  by  my  request  because  I  am  growing  more 
and  more  to  realize  the  importance  of  maintaining  health  and  efficiency, 
and  the  necessity  of  physiological  exercise  to  this  end. — Editor. 

INFLUENCE  OF  THE  HABITS   OF  THE   DENTIST   ON  THE   HEALTH 
OF  THE  ALIMENTARY  TRACT 

FIRST  PAPER 

Are  you  lazy?  Do  you  often  feel  that  to-day's  work  is  too  great 
an  effort  to  be  undertaken?  When  you  are  bent  over  a  patient  do  you 
sometimes  feel  that  it  would  be  a  relief  just  to  sit  down  and  do  nothing? 
Do  you  become  restless  and  want  to  do  something  else,  anything,  except 
that  which  you  are  doing?  Do  you  enjoy  your  meals  or  do  you  eat 
mechanically,  or  worse  still  do  you  often  feel  that  food  is  repulsive? 
Does  your  night's  sleep  refresh  you  or  do  you  arise  in  the  morning  feeling 
tired  and  xuifit  and  xmprepared  to  cope  with  the  day's  work? 

ONE  SOURCE   OF  LAZINESS 

Such  lack  of  vitality  as  has  been  described  above  may  result  from 
lack  of  tone  in  the  intestinal  tract,  from  incomplete  digestion  and  the 
absorption  into  the  body  of  intestinal  poisons.  It  may  be  corrected  by 
physiological  stimulation  of  the  weakened  functions. 

The  normal  functioning  of  the  alimentary  tract  is  chiefly  dependent 
on  four  things,  i.  e.,  muscular  tone,  digestive  secretions,  proper  position 
of  the  various  parts  of  the  tract,  and  proper  food  intake.  The  first  three 
of  these  cardinal  factors  are  influenced  both  separately  and  collectively 
by  a  number  of  conditions  which  are  under  the  control  of  the  individual. 
One  of  the  chief  of  these  conditions  would  seem  to  be  of  especial  interest 
to  dentists  because  of  its  close  connection  with  their  occupation.  It  is 
that  of  "sedentary  habit." 

SEDENTARY  HABIT,  TOXEMIA  AND  GROUCHES 

"Sedentary  habit"  is  present  in  the  history  of  practically  all  cases 
of  fecal  stasis  or  of  intestinal  toxemia,  which  come  under  observation. 
The  profession  of  dentistry  falls  undoubtedly  into  the  class  of  sedentary 


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156  THE  DENTAL  DIGEST 

occupations.  The  dentist  spends  all  of  his  producing  hours  indoors,  and 
in  the  larger  part  of  them  he  is  working  in  an  uncomfortable,  cramped, 
position,  over  the  operating  chair  or  the  laboratory  table.  Fresh  air 
and  exercise  form  practically  no  part  of  his  daily  routine.  His  field  of 
operation  is  extremely  narrow  and  limited,  affording  him  none  of  the 
opportunity  for  systemic  prophylaxis  that  comes  to  the  man  whose 
occupation  requires  activity  in  the  great  outdoors. 

** Sedentary  habit"  once  begun,  rapidly  develops  into  a  vicious  circle, 
and  unless  the  individual  is  forewarned  and  takes  pains  to  combat  this 
development  he  will  sooner  or  later  drift  into  that  class  of  pitied  speci- 
mens known  as  dyspeptics — hypochondriacs  or  just  plain  "grouches." 

LIMITED  EXERCISE  AND   THE   VICIOUS   SPIRAL 

Let  us  follow,  for  a  moment,  this  vicious  circle  of  which  we  have 
spoken,  and  watch  its  development.  Let  us  suppose  that  practicaDy 
all  of  the  time  for  a  week  or  more  the  dentist  has  been  indoors,  busy  over 
his  operating  chair  during  the  larger  part  of  his  working  hours.  The 
exerdse  which  he  has  taken  consisted  of  the  trips  between  office  and 
reception  room,  between  home  and  office  which  are  usually  situated  in 
comparative  proximity,  movements  in  the  abbreviated  radius  of  the 
operating  room  or  laboratory,  and  an  occasional  trip  to  the  theatre  in 
the  evening,  perhaps  made  in  the  stuffy  atmosphere  of  a  public  convey- 
ance. Exerdse  of  this  sort  has  required  little  muscular  activity.  What 
there  is  has  been  confined  to  a  very  limited  group  of  muscles  and  has 
therefore  been  little  better  than  no  exerdse  at  all.  Muscles  constitute 
about  half  the  body  weight  and  what  takes  place  in  them  profoundly 
influences  the  remainder  of  the  body  organs.  Lack  of  "muscular  meta- 
bolism," if  I  may  use  that  expression,  naturally  follows  absence  of  muscu- 
lar exercise,  much  to  the  detriment  of  the  rest  of  the  body.  As  the  result 
of  lack  of  exerdse  the  dentist's  muscular  tone  often  becomes  subnormal 
and  by  its  influence  on  the  rest  of  the  body  causes  a  lowering  in  tone  of 
the  musculature  of  the  intestinal  tract.  Peristalsis  is  delayed  and  weak- 
ened as  is  also  the  secretion  of  the  digestive  juices.  The  food  mass, 
which  should  have  been  excreted  within  about  seventy  hours  from  the 
time  of  ingestion  is  still  in  the  intestinal  tract.  It  has  long  since  under- 
gone complete  or  partial  digestion  and  the  residue  which  has  no  nutritive 
value  should  have  been  eliminated.  Remaining  in  the  large  intestine, 
it  frequently  forms  a  splendid  culture  media  for  all  sorts  of  micro- 
organisms among  which  are  some  of  the  putrefactive  enzymes.  These 
agents  become  active  and  produce  chemical  changes  in  the  fecal  mass 
which  liberate  toxins  of  various  kinds.  These  are  absorbed  and  sent, 
via  the  drculation,  all  over  the  body,  affecting  the  different  organs  and 


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FOOD  FOR  DENTISTS  157 

centres  in  a  manner  which  impairs  their  functional  activity.  Digestion 
which  is  already  poor  through  the  slowing  up  of  the  necessary  functional 
activities  due  to  lack  of  exerdse,  becomes  poorer.  The  appetite  fails  or 
disappears.  The  individual  becomes  easily  fatigued  and  complains  of 
feeling  mentally  and  physically  lazy. 

THE  WAY  OUT 

The  natural,  physiological  and  most  beneficial  prophylactic  and 
corrective  of  this  condition  is  to  take  sufficient  exercise  involving  the 
whole  body,  and  in  fresh  air  outdoors.  This  will  restore  and  maintain 
good  general  muscular  tone  and  through  that  proper  tonicity  of  the 
intestinal  musculature.  A  game  of  tennis  or  gplf,  a  "hike"  or  rowing  is 
better  than  any  artificial  stimulation. 

Physical  exercise  is  much  more  than  simply  a  means  of  developing 
muscular  strength.  Forty-two  per  cent,  of  the  body  weight  is  made 
up  of  muscles,  and  their  activity  very  greatly  influences  all  the  rest  of 
the  body  organs.  Exercise  strengthens  the  heart  and  blood  vessels 
which  are  called  on  to  send  more  blood  to  the  working  muscles.  It 
deepens  the  respiration  as  the  lungs  are  called  on  for  more  work.  It 
improves  the  appetite  and  helps  the  body  to  get  rid  of  waste  products. 
It  makes  the  brain  clearer  and  the  spirits  lighter. 

Every  one  should  provide  for  some  form  of  regular  physical  exercise 
if  his  work  does  not  require  energetic  muscular  effort.  Exercise  in  the 
open  air  such  as  walking,  not  loitering,  snow  shoeing,  skating,  riding,  and 
games  of  various  sorts  are  ideal  ways  of  keeping  the  muscular  system 
and  the  whole  body  in  good  working  order. 

The  exercise  must  not,  however,  be  too  strenuous.  It  must  not  be 
carried  past  the  point  of  moderate  fatigue  and  must  not  be  violent  in 
character.  The  one  extreme  of  too  violent  exercise  is  as  undesirable  as 
the  other  extreme  of  too  little. 

THE  BODY  AS  A  FURNACE 

The  human  body  must  be  regarded  as  in  much  the  same  light  as  the 
household  furnace.  As  with  the  furnace,  the  fuel  must  be  fed  at  regular 
intervals  and  it  must  be  of  the  proper  kind,  but,  of  equal  importance,  is 
the  timely  removal  of  the  ashes,  in  the  proper  manner.  Let  the  ashes 
remain  in  the  fire  bed  and  the  function  of  the  furnace  becomes  greatly 
impaired.  The  draught  is  obstructed  and  the  heat  of  the  fire  become 
progressively  less.  The  situation  in  the  human  body,  when  proper  care 
is  not  taken  to  establish  a  metabolic  equilibrium,  becomes  quite  analagous 
to  that  in  the  furnace. 

It  may  be  argued  that  cathartics  and  laxatives  can  be  used  as  re- 


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158  THE  DENTAL  DIGEST 

quired  to  establish  entero-colonic  activity,  but  the  answer  to  this  is  that 
this  means  affords  only  temporary  relief  at  best,  its  final  result  being  the 
development  of  the  cathartic  habit,  which  is  as  bad  or  worse  than  the 
sedentary  habit.  A  function  which  should  be  normal  and  will  respond  to 
natural  causes,  cannot  be  activated  indefinitely  with  artificial  stimuli. 
Take  the  right  amount  of  exercise,  regularly,  and  it  is  not  likely  you 
will  have  any  need  for  other  therapeusis.  You  will  feel  better,  look 
better  and  be  better.    The  chief  causes  of  your  complaints  will  disappear. 

{To  be  continued) 


AN  ORIGINAL  LETTER  TO  A  DENTIST* 

Dr.  G. M.,  III.,  Oct.  9th  1905. 

Dear  Sir: 
I  find  of  a  necesary  that  I  must  have  some  thing  did  to  my  teeth,  I  Can 
not  say  just  what,  or  weather  any  more  than  good  advice,  but  providing 
I  shall  make  up  my  mind  to  have  any  teeth  Extracted,  Can  you  have 
yourself  provided  with  a  positively,  I  was  going  to  say  painless  article. 
a  gum  freezer  to  make  num.  Can  this  be  did  under  any  circumstance. 
Or  is  it  a  say  say,  saying. 

I  have  of  course  had  teeth  extracted  at  times  successfully  so  far  as  that 
work  was  did.  but  so  severe  pain.  As  my  nerve  system  has  been  so 
shocked  for  years  this  is  why  I  want  to  know  if  can  be  in  tirly  over  come 
without  taking  gas,  which  I  should  prefir  not  to  do. 
I  have  had  this  past  week  an  other  dreadful  attact  of  mewralga  caused  by 
catching  cold  in  these  teeth,  they  are  no  how  whole  any  more,  a  number 
with  the  crumbling  tops  intirley  gon;  and  yet  they  are  aparently  im- 
planted in  the  jaw  generally  solid  as  rocks,  this  is  why  I  fear  and  dread 
the  process,  if  they  was  loose  &  rigley  I  should  not  hesitate.  I  will  prob- 
ley  place  in  my  order  for  Friday  perhaps  a  bout  half  past  ten.  I  mean  an 
order  to  taulk  with  you  if  you  are  not  busey.  I  am  trying  to  draw  the 
information  nice  as  I  can  so  there  will  not  be  so  much  swelling  and  soar- 
ness.  in  this  spell  it  reach  such  a  degree  at  one  tooth  Root  as  to  cause  an 
abcess  to  form  which,  came  to  a  head,  on  the  gum  in  side.  You  may 
conclude  of  course  that  I  suffered  much  Pain  in  this,  and  to  press  on  the 
gum  at  this  place  feels  as  if  there  was  a  sack  or  cusion  like,  this  I  hope  to 
have  in  better  shape  By  Friday.  I  do  not  know  sure  but  think  this  was 
the  Eye  tooth  as  we  call  it. 
I  wish  they  was  in  the  Bottom  of  the  Sea  any  way. 
We  hope  you  are  all  well. 
I  will  try  and  kep  up  courage  to  come  and  see  you  any  way. 

Respfully  Yours 
*Nwue  withheld  by  request.  . 


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Seest  thou  a  man  diligent  in  business? 
He  shall  stand  before  kings;  he  shall  not 
stand  before  mean  men. 

— Proverbs  xxli,  29, 

THE  BUSINESS  SIDE  OF  PROPHYLACTIC  AND 
RESTORATIVE  PRACTICE* 

By  W.  F.  Spies,  D.D.S.,  and  George  Wood  Clapp,  D.D.S.,  New  York 

RESTORATIVE  DENTISTRY 
THIRD  PAPER 

By  restorative  work  is  here  meant  all  those  operations  which  are 
employed  in  restoring  the  natural  teeth  to  a  condition  of  masticating 
eflSdency,  and  replacing  lost  teeth.  This  includes  the  treatment  and 
filling  of  roots  when  necessary,  the  restoration  of  crowns  to  proper  con- 
tact with  adjacent  teeth  and  articulation  with  opposing  teeth,  either  by 
means  of  fillings  or  porcelain  or  gold  crowns. 

It  is  obvious  that  in  making  records  for  this  sort  of  service,  some  stan- 
dard of  excellence  must  be  established,  since  these  operations  may  be 
performed  in  much  less  time  if  the  quality  of  service  is  not  to  be  con- 
sidered. Thus  if  roots  are  to  be  carelessly  or  hurriedly  treated,  if  inlays 
or  crowns  are  not  to  be  contoured  to  contact  and  carved  to  articulating 
and  masticating  efficiency,  the  cost  of  each  operation  will  be  much  less. 
It  is  of  little  use  to  estimate  on  the  cost  of  an  inferior  quality  of  service, 
since  it  usually  brings  the  mouth  to  a  worse  condition  than  the  first, 
within  a  brief  period  of  time. 

A  SCHEME  FOR  COMPUTING  COSTS  OF  RESTORATIVE  OPERATIONS 

Our  experience  in  the  relatively  new  field  of  keeping  accurate  costs 
of  dental  operations  has  enabled  us  to  devise  classifications  which  we 
believe  may  be  adopted  by  dentists  generally  to  the  end  that  the  costs  of 
operations  may  be  computed  by  different  dentists  on  a  simUar  basis. 
This  permits  comparison  between  different  computations  to  the  benefit 
of  aU. 

As  in  most  other  activities,  we  have  learned  only  by  experience,  and 
while  we  are  now  computing  costs  according  to  this  classification,  there 
are  numerous  items  concerning  which  we  have  no  data.    We  hope  to  be 

*This  article  began  in  the  January  191 6  number. 


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160 


THE  DENTAL  DIGEST 


able  to  offer  such  data  in  the  future,  and  in  the  meantime  shall  be  glad 
to  have  the  cooperation  of  all  dentists  who  desire  to  see  some  intelligent 
classification  for  costs  generally  adopted. 

PULP  EXTIRPATION  AND  ROOT  FILLING 

This  class  of  work  presents  three  general  divisions — one  in  which  the 
pulp  must  be  removed  from  a  sound  tooth  that  it  may  be  used  as  an  abut- 
ment, another  in  which  decay  is  present  without  exposure,  and  a  third 
in  which  there  is  an  exposed  or  putrescent  pulp.  In  cases  of  inflamed 
pulps,  palliative  treatment  may  be  necessary  before  devitalization  and 
post-operative  treatment  after  extirpation.  Illustration  No.  4  presents 
the  three  conditions  of  the  teeth  and  it  is  believed  that  the  form  below 
it  enables  the  dentist  to  record  the  time  of  each  step  of  the  operation. 
He  can  then  compute  the  cost  by  multiplying  the  income-hour  fee  by  the 
time. 


I 


7.  Number  of  Cases 

8.  Average  Time 

9.  Average  Cost 


Fig.  4.    Illustration  and  fonn 

(0 
Time  Report: 

1.  Palliative  Tr.      .     .  4.  Extirpate     .... 

2.  Appl.  As.       .     .      .  s.  Post  Tr 

3.  Pressure  Anes.    .  6.  Filling 

(Incisors,  Bicuspids  and  Molars). 

*Our  records  at  present  show  the  following: 

No.  8.    Devitalizing  healthy  anterior  teeth  for  abutments,  no  cavities. 

Forty-eight  cases  from  three  dentists.     Total  time  for  all  cases  42  hours, 

divided  as  follows: 

Application  of  Arsenious  Acid  and  pressure  anesthesia       .......     12  hours 

Removals  of  pulps  and  post-operative  treatment 17    " 

Filling  roots 13    " 

42  hours 

Average  time  52  minutes.  In  each  of  these  cases  a  cavity  was  drilled 
into  the  sound  tooth  structure  and  Arsenious  Acid  sealed  in  from  24  to  48 
hours.  An  exposure  of  the  pulp  was  then  made,  pressure  anesthesia 
applied,  the  pulp  removed.     Cost  as  per  table  following: 

Class  I  Class  U        Class  III        Class  IV  Class  V 

Minimum  hourly  fee  $1.45  $2.22  $3.13  $3.94  $4.89 

Average  cost       .     .  1.30  1.91  2.60  3.38  4.16 

*The  numbers  given  to  these  operations  correspond  to  the  numbers  in  Chapter  16,  "Profit- 
able Practice,"  from  which  they  are  taken. 


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BrSINESS  SIDE  OF  PROPHYLACTIC  AlTD  RESTORATIVE  PRACTICE      161 

No.  lo.  Soothing  pulpitis,  removing  anterior  pulps,  filling  canals. 
Forty-one  cases  from  30  dentists.  Average  time  45  minutes.  Costs  as 
per  table  following: 

Class  I  Class  II         Class  III        Class  IV  Class  V 

Minimum  hourly  fee  $i-45  $2.22  $3- 13  $3-94  4-^9 

Average  cost        .     .  1.12  1.63  2.25  2.92  3.50 

No.  7.  Devitalizing  healthy  anterior  teeth  and  filling  roots,  no  ex- 
posure, pressure  anesthesia.  Sixty  cases  from  50  dentists.  Average  time 
30  minutes.  The  records  do  not  show  whether  or  not  there  were  cavities 
in  the  teeth,  and  to  this  extent  are  indefinite.  Costs  as  per  table  follow- 
ing: 

Class  I  Class  U        Class  III        Class  IV  Class  V 

Minimum  hourly  fee  $i-45  $2.22  $3 -13  S3 -94  $4-^ 

Average  cost  .     .     .  .72  i.ii  1.56  1.97  2.44 

No.  9.  Removal  of  exposed,  anterior  pulps,  not  inflamed,  pressure 
anesthesia,  filling  canals.  59  cases  from  50  dentists.  Average  time  25 
minutes.     Costs  as  per  table  following: 

Class  I  Class  II         Class  III        Class  IV  Qass  V 

Minimum  hourly  fee  $145  $2.22  $3- 13  $3-94  $4  89 

Average  cost  ...  .62  .75  1.25  1.62  2.00 

No.  II.    Treating  putrescent  anterior  canals  and  filling  roots.     53 

cases  from  46  dentists.    Average  time  i  hour  and  15  minutes.    Average 

cost  as  per  table. 

Class  I  Class  II        Class  IH        Class  IV  Class  V 

Minimum  hourly  fee  $145  $2.22  $3- 13  S3. 94  $4  89 

Average  cost  ...  1.87  2.25  3.75  4.85  6.co 

Technic  same  as  No.  8,  20  bicuspids  from  three  dentists. 

Application  of  Arsenious  Acid  and  pressure  anesthesia 5  hours 

Extirpation  and  post-operative  treatment 12     " 

Root  filling 9    " 

Average  time  i  hour  18  minutes.     Cost  as  per  table  following: 

Class  I  Class  II         Class  III        Class  IV  Class  V 

Minimum  hourly  fee  $i-45  $2.22  ^3-^3  $3-94  $4  89 

Average  cost        .     .  1.95  2.34  3.90  5.07  6.24 

No.  12.  Removing  healthy  bicuspid  and  molar  pulps.  218  cas23 
from  60  dentists.    Average  time  65  minutes.    Costs  as  per  table  following : 

Class  I  Class  II         Class  III        Class  IV  Class  V 

Minimum  hourly  fee  $i-45  $2.22  $3-^3  S3  94  $4-^ 

Average  cost  .     .     .  1.62  1.95  3.25  4.22  5.20 

Technic  same  as  No.  8,  12  molars  from  3  dentists. 

Application  of  Arsenious  Acid  and  pressure  anesthesia 7  hours 

Extirpation  of  pulps  and  post-operative  treatment 7     " 

Root  filling: 8    " 


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THE  DENTAL  DIGEST 


Average  time  i  hour  and  50  minutes.     Cost  as  per  table  following  : 
Class  I  Class  II         Class  III        Class  IV  Class  V 

Minimum   hourly  fee  $i-45  $2.22  $3- 13  $3-94  $4-^9 

Average  cost  ...  2.75  4.07  5.50  7.15  8.80 

No.  13.  Treating  putrescent  molars  and  filling  roots.  92  cases 
from  40  dentists.  Averjige  time  i  hour  and  45  minutes.  Costs  as  per 
table  following: 

Class  I  aass  IT        Class  III        Class  TV         Class  V 

Minimum  hourly  fee  $i-45  $2.22  $3-^3  $3-94  $4-8q 

Average  cost  .     .     .  2.62  3.85  5.25  7.15  8.80 

No.  15.  Treating  putrescent  molars,  filling  roots,  filling  crowns  with 
amalgam.  49  cases  from  40  dentists.  Average  time  2  hours,  10  minutes. 
Costs  as  per  table  following: 

Class  I  Class  II        Class  III        Class  IV  Chiss  V 

Minimum  hourly  fee  $i-45  $2.22  %3-iS  $3-94  $4-89 

Average  cost  .     .      .  3.25  3.90  6.50  8.45  10.40 

No.  16.  Treating  putrescent  teeth,  kind  of  teeth  and  care  in  treat- 
ment not  specified.  93  cases,  20  dentists.  Average  time  i  hour,  25 
minutes.     Costs  as  per  table  following: 

Class  I  Class  II         Class  III        Class  IV         CUss  V 

Minimum  hourly  fee  $1  ■  45  $2.22  $3  •  13  S3  ■  94  $4-89 

Average  cost  .  2.12  3. 11  4.25  5.52  6.80 

CLASSIFICATION   OF   CAVITIES 

It  is  believed  advisable  to  follow  the  cavity  classification  of  Dr. 
Thos.  E.  Weeks,  as  given  in  the  American  Text-book  of  Operative  Dentistry. 
The  illustrations  are  doubtless  sufficient  without  description. 


nius.  No.  4. 


7  8 

Fillings  in  simple  cavities 


Time  Report: 

1.  Cav.  Prep 5.  Number  of  cases 

2.  Introduction 6.  Average  time         

3.  Wax  model 7.  Average  material 

4.  Laboratory 8.  Average  cost  

(Gold,  Foil,  Inlay,  Alloy,  and  Cement) 

Our  records  at  present  show  the  following: 

No.   25.     Simple  amalgam  or  cement  fillings.     473  cases  from 
dentists.     Average  time  25  minutes.     Costs  as  per  table  following: 


65 


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BUSraESS  SIDE  OF  PROPHYLACTIC  AND  RESTORATIVE  PRACTICE      163 


Class  I 

Class  II 

Class  III 

Class  IV 

Class  V 

Minimum  hourly  fee 

$1.45 

$2.22 

^3-^3 

$3.94 

S4.89 

Average  cost  .     .     . 

.62 

.89 

I-2S 

1.62 

2.00 

The  term  "simple"  is  here  employed  to  describe  a  filling  involving 
only  one  surface  of  a  tooth.  No  records  of  the  care  exercised  in  any  of 
the  steps  are  available.  Three  hundred  and  nineteen  of  these  fillings 
were  reported  as  averaging  30  minutes,  but  87  were  reported  by  one 
dentist  as  reqiiiring  only  10  minutes  each,  which  reduced  the  general 
average.  Such  variation  in  records  emphasizes  the  fact  that  each  dentist 
should  compile  his  own  time  records  as  a  basis  for  his  own  minimum  fees. 

No.  30.  Simple  gold  foil  fillings.  42  cases  from  15  dentists.  Aver- 
age time  30  minutes.     Costs,  exclusive  of  gold,  as  per  following  table. 

Class  I  Class  II        Class  III        Class  IV  Class  V 

Minimum  hourly  fee  $i-45  $2.22  $3- 13  $3-94  $4-89 

Average  cost  ...  .72  i.ii  1.56  1.97  2.44 

No.  32.  Simple  gold  inlays.  72  cases  from  40  dentists.  Average 
time  I  hour,  20  minutes.     Costs,  exclusive  of  gold,  as  per  table  folloi;ring: 

Class  I  Class  H        Class  III        Class  IV  Class  V 

Minimum  hourly  fee  $i-45  $2.22  $3- 13  $3-94  $4-89 

Average  cost  .  2.00  2.96  4.00  5.20  6.40 


II  12 

lllus.  No.  5.    Fillings  in  compound  cavities 

Time  Report: 

1.  Cav.  Prep 5.  Number  of  cases 

2.  Introduction 6.  Average  time         

3.  Wax  model 7.  Average  Material 

4.  Laboratory 8.  Average  cost  

(Gold,  Foil,  Inlay,  Alloy,  and  Cement) 

No.  26.  Compound  amalgam  and  cement  fillings.  161  cases  from 
60  dentists.  Average  time  45  minutes.  Costs,  as  per  table  following. 
The  term  '* compound"  is  here  employed  to  indicate  a  filling  restoring 
two  or  more  surfaces  of  a  tooth. 

Class  I  Qass  II        Class  III        Class  IV  Class  V 

Minimum  hourly  fee  $145  $2.22  $3- 13  S3 -94  ^4-89 

Average  cost  ...  1.12  1.63  2.25  2.92  3.60 

No.  33.  Compound  geld  inlays.  95  cases  from  10  dentists.  Aver- 
age time,  I  hour  55  minutes.  Cost,  exclusive  of  gold,  as  per  table 
following. 


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164  THE  DENTAL  DIGEST 


Class  I 

Class  II 

Class  III 

Class  IV 

Class  V 

Minimum  hourly  fee 

$1-45 

$2.22 

$3- 13 

$3-94 

^.89 

Average  cost  .     .     . 

2.87 

4.22 

5.75 

7.47 

9.20 

No.  34.  Extensive  gold  inlays,  character  not  otherwise  specified, 
16  cases,  average  time  3  hours,  20  minutes.  Costs,  exclusive  of  gold, 
as  per  table  following: 

Class  I  aass  II        Class  III        Class  IV  Class  V 

Minimum  hourly  fee  $i-45  $2.22  tS-^S  $3  94  $4 -89 

Average  cost  5.00  7.40  10. co  13. 00  16. co 

No.  35.  Finely  carved  and  contoured  gold  inlays  in  bicuspids  and 
molars.  52  cases  from  one  dentist.  Average  time,  2  hours  45  minutes. 
Costs,  exclusive  of  gold  as  per  table  following.  The  gold  cost,  on  the 
average,  $1.20  per  inlay. 

Class  I  Class  II         Class  III 

Minimum  hourly   fee  $1-45  $2.22  S3. 13 

Average  cost  ...  4.12  6.07  8.25 

To  be  cofUintied. 


Class  IV 

Class  V 

S3-94 

S4.89 

10.72 

13  20 

Editor  Dental  Digest: 

In  the  various  articles  pro  and  con  on  dental  advertising  as  pub- 
lished in  the  Digest  the  past  year,  one  point  seems  to  have  been  missed. 
Suppose  it  were  perfectly  legitimate  for  all  dentists  to  advertise  and  all 
dentists  did  so,  what  advantage  would  one  have  over  another?  If  one 
were  not  capable  of  good  advertising  could  he  not  revert  to  a  professional 
advertisement  writer  and  thus  do  as  good  advertising  as  the  other  fellow, 
and  all  advertising  being  equal  would  there  not  be  a  large  expense  thus 
added  to  the  dental  profession  without  any  advantage  to  any  one  party? 
Any  dentist  of  good  morals,  of  fair  workmenship,  attentive  to  business, 
associating  with  only  the  best  of  associates  and  being  conspicuous  in 
public  affairs  need  not  even  see  wolf  tracks  within  a  hundred  miles  of  his 
office  or  home,  and  a  country  crossroads  may  be  his  place  of  business. 
I  might  add  that  a  man  of  good  morals  is  necessarily  one  clean  in  person 
and  office. 

Any  author  of  an  article  written  the  past  year  in  the  Digest  com- 
plaining of  poor  business  and  professional  abuse  by  the  other  fellow  can 
diagnose  his  case  in  these  last  few  lines  and  can  if  he  will  prescribe  for 
himself  successfully. 

One  who  has  been  through  the  mill  and  did  diagnose  himself. 

R.  A.  W. 


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DENTISTRY  FROM  A  FINANCIAL  ASPECT  165 

DENTISTRY  FROM  A  FINANCIAL  ASPECT* 

By  Percy  A.  Ash,  D.D.S. 

Editor  "CommonweaUh  Dental  Review f''  Lecturer  and  Examiner  University  of  Sydney,  Etc, 

The  dentist  who,  so  to  speak,  can  only  do  what  he  was  actually  taught 
while  at  college  will  be  a  partial,  if  not  a  complete,  failure.  There  is 
probably  no  vocation  which  affords  so  much  scope  for  personal  ingenuity 
as  the  mechanical  side  of  dentistry.  Think  of  the  many  cases  presented 
to  you  which  are  quite  different  to  any  you  have  seen  before.  Each  must 
be  dealt  with  entirely  in  its  own  merits.  Fixed  and  removable  bridges, 
vulcanite  and  metal  plates,  inlay  abutments,  and  many  other  methods  im- 
mediately flit  through  your  mind,  and  upon  your  ability  to  grasp  quickly 
and  intelligently  all  the  alternatives,  and  eventually  decide  on  the  one 
which  will  give  the  best  service,  combined  with  the  greatest  comfort,  will 
depend  the  measure  of  success  which  you  have  in  practice. 

Dentistry  cannot  always  be  carried  out  on  the  definite  lines  set  out  in 
books  any  more  than  particular  business  enterprises  can  invariably  be 
built  up  on  the  old-fashioned  lines.  Braddon,  again,  on  this  point  says, 
''A  torpid  mind,  fatal  in  business,  will  cling  desperately  to  the  established 
methods.  Hating  change,  a  quick,  original  mind  will  always  be  ready  at 
any  rate  to  weigh  new  ideas  and  to  sympathetically  appreciate  the  possi- 
bilities of  suggested  innovations." 

There  are  many  details  in  connection  with  the  conduct  of  a  dental 
practice  which  count  for  a  great  deal,  and  are  often  neglected,  either 
through  carelessness  or  the  lack  of  a  proper  knowledge  of  the  fitness  of 
things.  If  a  patient  telephones  for  an  appointment,  and  especially  if  he 
asks  for  a  definite  time  which  will  suit  his  convenience,  is  it  not  worth  while 
to  personally  speak  to  him  after  your  secretary  has  taken  the  message, 
and  arrange  something  suitable  to  him?  It  gives  him  an  excellent  im- 
pression of  the  interest  you  take  in  those  who  consult  you.  If  a  friend 
sends  a  patient  to  you,  surely  the  first  thing  to  do  is  to  thank  him  for  his 
kindness;  the  omission  of  it  is  an  unpardonable  offence.  When  a  new 
patient  arrives  at  your  rooms,  spare  a  moment  to  greet  him  yourself,  and, 
if  he  is  there  by  appointment,  do  not  keep  him  waiting;  in  any  case,  if 
he  is  in  pain,  assure  him  that,  irrespective  of  inconvenience  to  yourself, 
you  will  see  him  within  a  few  minutes  and  endeavor  to  make  him  comfort- 
able. Many  such  small  matters  might  be  mentioned  which  are  fre- 
quently overlooked.  There  is  no  room  in  the  dental  profession  for  the 
man  who  is  casual;  he  must  be  ever  on  the  alert,  and  make  the  most  of 
every  chance.  Those  who,  in  other  walks  of  life  as  well  as  our  own,  ex- 
^Continued  from  February  Digest. 


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166  THB  DENTAL  DIGEST 

cuse  their  failures  on  the  ground  that  business  generally  is  bad  and  money 
scarce,  are  very  often  themselves  to  blame.  It  is  idle  to  talk  of  the  good 
old  times  which  will  never  return.  The  world  is  full  of  opportunities; 
they  come  knocking  at  our  doors  every  day.  The  quicjc  and  intelligent 
man  takes  hold  of  them,  the  pessimist  fails  to  see  them,  while  the  drone 
does  not  trouble  himself  one  way  or  the  other. 

A  feature  of  great  importance  in  any  business  or  profession  is  the 
ability  to  properly  conduct  correspondence.  Few  things  are  noticed 
more  by  an  educated  man  than  the  receipt  of  a  letter  badly  constructed 
and  with  faulty  spelling.  Bear  in  mind  that  professional  men  are  ex- 
pected to  be  educated  to  the  extent,  at  least,  that  they  can  correctly  ex- 
press themselves  in  the  language  they  speak.  It  is  regrettable  to  have  to 
admit  that  there  are  very  many  who  cannot;  and  here  let  me  say  that 
they  should  fill  in  all  the  spare  time  at  their  disposal  in  improving  them- 
selves in  that  direction.  It  is  no  disgrace  that  through  force  of  circum- 
stances one  has  not  had  the  advantages  of  a  good  education  in  early  life, 
but  it  is  unpardonable  not  to  try  and  make  up  the  deficiency  later  when 
one  has  the  means  at  his  disposal.  Surely  the  ability  to  properly  speak 
and  capably  state  one's  thoughts  on  paper  is  one  of  the  essentials  toward 
success;  it  certainly  is  one  of  the  greatest  assets  which  a  man  can  have  who 
intends  to  follow  an  occupation  in  life  which  will  bring  him  in  personal 
contact  with  people  of  refinement,  and  I  presume  that  all  of  us  aspire  to 
have  that  class  of  people  for  our  patients.  It  is  a  constant  source  of  sur- 
prise to  me  why  so  many  comparatively  young  men  seriously  lacking  in 
this  way  do  not  spend  some  of  their  evenings  attending  classes  of  instruc- 
tion, or  else  studying  in  private  with  capable  tutors. 

The  point  I  want  to  make  in  mentioning  such  matters  as  these  is  that 
very  many  of  us  are  either  wilfully  or  unconsciously  blind  to  our  own  short- 
comings, and,  as  a  result,  we  have  to  suffer.  In  other  words,  we  fail  for 
one  reason  or  another  to  take  accurate  stock  of  ourselves.  We  are  ready 
enough  to  pronounce  that  some  other  class  of  business  failed  because  the 
manager  of  it  was  incompetent;  but  for  our  own  failures,  we  lay  the  blame 
anywhere  but  at  our  own  doors.  It  is  no  use  attempting  to  decry  the 
successful  practitioner  on  the  other  side  of  the  street  by  saying  that  you 
are  as  good  a  man  as  he  is,  and  that  your  professional  qualifications  were 
obtained  at  schools  equal  in  standard  to  those  where  he  took  his  degrees, 
for  the  fact  remains  that  he  has  succeeded  and  you  have  failed.  The 
thing  to  do  is  to  ascertain  accurately  his  personal  qualities,  and  then 
compare  his  methods  of  conducting  a  practice  with  your  own.  Many  of 
us  have  attractive  points  which  have  never  been  developed.  A  good  plan 
would  be  to  spend  some  of  the  money  we  otherwise  waste  in  seeking  the 
help  of  those  competent  to  bring  out  those  latent  qualities  to  the  best 


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DENTISTRY  FROM  A  FINANCIAL  ASPECT  167 

advantage.  Money  is  given  us  to  make  good  use  of,  and  surely  it  can  be 
put  to  few  better  purposes  than  to  assist  in  the  development  of  char- 
acter and  those  many  personal  accomplishments  essential  to  success. 

Someone  has  written  that  the  way  to  succeed  is  to  work  hard  and 
advertise.  The  necessity  for  hard  work,  especially  in  these  exceptional 
times  of  war  and  distress,  when  it  is  gradually  becoming  a  more  difficult 
problem  to  make  two  ends  meet,  is  beyond  argument;  but  the  question  of 
advertising  is  one  that  is,  and  always  will  be,  open  to  much  contention 
in  so  far  as  professional  men  are  concerned.  The  style  so  objectionable  is 
the  hideous  signboard  or  the  flaring  announcement  in  public  print,  more 
especially  when  statements  are  made  not  in  accordance  with  fact.  It 
has  been  said  that  the  advertising  which  never  shows  in  a  magazine  or 
on  a  signboard  has  more  influence  on  individual  lives  than  all  the  wonder- 
ful public  array  of  words  with  which  we  are  all  so  familiar.  What 
constitutes  legitimate  advertising  within  the  profession  of  dentistry  is  a 
matter  too  large  to  go  into  this  evening.  Each  man  must  decide  for 
himself,  but  let  him  make  his  decision,  if  possible,  after  closely  studying 
the  methods  of  practitioners  who  have  built  up  successful  practices  upon 
lines  recognized  by  all  around  them  to  be  highly  ethical. 

It  may  appear  to  some  members  of  the  profession  that  my  remarks  so 
far  have  consisted  largely  of  platitudes  and  preaching.  They  may  say 
that  they  already  know  all  I  have  remarked,  and  have  found  it  of  no  avail. 
They  may  also  say  that  they  have  read  the  sayings  of  philosophers  and 
commercial  magnates,  and  have  found  them  of  no  practical  use.  That  is 
just  the  point  I  wanted  to  lead  up  to.  If  some  of  us  have  heard  and  read 
these  wise  words,  uttered  in  many  instances  by  men  who  have  climbed  to 
the  top  of  the  tree,  and  have  not  found  them  a  help  on  the  road  to  success 
in  practice,  well,  then,  we  should  be  brave  enough  to  look  the  whole  mat- 
ter squarely  in  the  face,  admit  that  we  have  missed  our  vocation  in  life, 
and  then,  with  that  energy  and  determination  which  characterizes  the 
British  race,  relinquish  dentistry  and  try  our  fortunes  elsewhere.  That 
is  the  sum  total  of  the  whole  argument,  and  there  is  no  need  to  speak  fur- 
ther upon  it. 

BANKING  ACCOUNTS 

No  person  whose  financial  transactions  amount  to  any  sum  worth 
mentioning  should  fail  to  have  a  current  banking  account.  Very  many 
people  get  their  monetary  affairs  into  a  state  of  chaos  by  keeping  their 
accoimts  in  their  pockets,  so  to  speak.  We  shall  again  take  the  case  of 
the  careless  professional  man  who  does  not  understand  bookkeeping,  and 
thinks  that  a  bank  pass  book  will  be  a  nuisance  to  him.  Rather  than 
employ  pii  accountant,  he  simply  receives  and  pays  out  bis  money  as  occa- 


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168  THB  DENTAL  DIGEST 

sion  arises.  A  patient  pays  him  ten  guineas,  which  he  puts  into  his 
pocket.  An  hour  or  two  later  a  tradesman  calls  with  a  bill  for  £5-10-6. 
He  pays  it  out  of  the  ten  guineas  he  has  received,  and  simply  puts  the 
receipt  on  a  file.  He  receives  and  pays  money  in  the  same  manner  month 
after  month,  and  so  long  as  he  can  put  his  hand  in  his  pocket  for  what  he 
wants,  he  is  satisfied  that  he  is  keeping  on  the  right  side.  He  probably 
notes  down  on  scraps  of  paper  what  patients  owe  him,  but  keeps  no  accur- 
ate records  of  his  own  debts,  and  therefore  frequently  receives  more  or 
less  of  a  shock  when  his  creditors  present  him  with  statements  of  their 
claims.  If  he  happens  to  have  sufficient  money  about  him  when  one  of 
them  calls,  he  will  perhaps  pay  on  the  spot;  if  not,  he  will  say  to  call  again. 
It  is  quite  certain  that  a  man  with  a  practice  or  business  of  any  extent 
cannot  ascertain  at  short  notice  how  he  stands  without  keeping  proper 
accounts,  and  it  is  also  certain  that,  with  the  methods  of  exchange  as  we 
have  them  now,  he  cannot  conduct  his  affairs  satisfactorily  without 
keeping  an  account  at  a  bank.  In  making  this  last  remark,  I  have  par- 
ticularly in  mind  the  system  of  giving  cheques.  In  Australia,  especially, 
the  custom  of  settlement  by  cheque,  instead  of  bank  notes  or  coin  of  the 
realm,  has  now  become  so  firmly  established  that  one  is  practically  forced 
to  adopt  the  system,  and  the  adoption  of  it  necessitates,  of  course,  a  bank- 
ing account.  Whether  you  pay  all  your  own  debts  in  cash  or  not,  you 
will  find  that  the  great  majority  of  other  business  people  do  not.  They 
will  pay  you  by  cheque,  and  how  are  you  to  get  value  for  those  cheques 
imless  you  pass  them  through  your  banking  account.  To  be  sure,  some 
few  of  them  may  be  "open"  cheques  and  be  drawn  on  the  local  bank,  in 
which  case  you  or  your  secretary  could  obtain  cash  over  the  counter; 
but  by  far  the  greater  number  will  be  "crossed"  or  drawn  on  a  bank 
away  from  the  part  in  which  you  reside.  By  an  "  open  "  cheque  is  meant 
one  that  is  payable  to  the  bearer  of  it,  that  is  not  crossed,  not  made 
specially  payable  to  any  particular  person,  or  restricted  in  any  way;  in 
other  words,  a  cheque  which,  if  picked  up  by  a  stranger,  or  even  stolen,  is 
payable  to  the  person  who  presents  it,  provided,  of  course,  the  drawer  has 
sufficient  funds  to  meet  it.  Any  drawer  of  a  cheque  has  the  right  to 
request  his  bank  to  refuse  payment  of  it  if,  for  instance,  it  has  been  stolen 
or  lost;  but,  at  the  same  time,  it  is  very  questionable  if  the  bank  could 
be  held  liable  should  it  pay  the  same  by  mistake,  assuming  that  it  was 
properly  drawn;  in  fact,  a  bank  always  requires  a  written  request  to  stop 
payment,  and  a  clause  is  usually  embodied  in  that  request  to  the  effect 
that  the  bank  shall  be  held  harmless  in  the  event  of  the  cheque  being  paid 
in  error.  Also,  the  instructions  to  stop  payment  will  not  hold  good 
against  any  person  who  has  obtained  it  in  good  faith  and  given  value  for  it. 
Such  a  person  c^n  recover  either  from  the  bank  or  the  drawer. 


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DENTISTRY  FROM  A  FINANCIAL  ASPECT  169 

If,  then,  you  decide  to  keep  a  bank  account,  it  is  most  important  that 
all  money  you  receive  in  connection  with  your  business  transactions 
passes  through  that  account — not  merely  the  cheques  and  the  larger 
amounts  in  notes  and  gold,  but  the  humble  odd  half-crowns  also.  On 
the  other  hand,  let  all  your  paymfenta  bb  bV  cKeq\fft  \>f  out  of  some  loose 
cash  which  you  have  on  hand,  but  which  *forms  part  of  a  previous  amount 
which  you  drew '^oiit- for 'sundry  duXrent  exper.Ses.  -As -you  3w5Il  be  cou'^ 
stantly  disbursing  small  sums  for  6M  pufposfe  bf  aftotH^r",  It  Ts  Veil  fo 
draw  a  cheque  for,  say,»£5»for'|>efty  cash,  and.  g^t'ch'aAj^^'^fdjrnt,  to  be 
paid  out  as  required.  If  yotrcafre  tcrkfcep  £f  tecdiy  <5f  411  the  trifles  so  paid 
out,  for  your  own  information,  well  and  good,  but  it  will  not  affect  the 
balancing  of  your  bank  account.  Many  practitioners  (myself  included) 
do  not  worry  over  the  details  of  petty  cash.  If  you  keep  the  amount 
for  that  purpose  in  your  own  pocket,  you  will  know  that  it  all  has  been 
rightly  disposed  of;  but  if  your  secretary  has  charge  of  it  and  you  have 
authorized  her  to  use  it,  as  necessary,  without  special  reference  to 
you  on  each  occasion,  then  it  would  be  better  for  her  to  keep  a  record  of 
all  payments,  as  much  for  her  own  satisfaction  as  for  your  information. 

If  you  understand  little  or  nothing  in  regard  to  keeping  and  balancing 
a  proper  cash  book  kept  free  of  charge  to  yourself.  Each  customer  is 
entitled  to  receive  from  the  bank  a  pass  book,  which  sets  out  proper 
details  of  all  amounts  received  and  paid  away.  If,  therefore,  you  pay 
all  you  receive  into  your  account,  and  draw  cheques  for  all  you  want, 
you  can,  by  merely  obtaining  your  pass  book  from  time  to  time,  ascertain 
exactly  how  you  stand;  that  is  to  say,  you  would  go  through  the  book, 
check  the  amounts  charged  against  you  with  those  in  the  butts  of  your 
cheque  book,  and  then,  allowing  for  any  cheque  unpresented,  merely 
subtract  the  one  side  from  the  other.  It  is  better,  under  such  cir- 
cumstances, to  draw  your  cheques  in  favor  of  the  persons  you  pay,  or 
else  the  name  of  the  goods  you  are  obtaining  instead  of  in  favor  of 
numbers,  as  at  any  time  you  will  then  be  able  to  search  through  your 
pass  book  and  ascertain  the  amount  of  money  you  have  paid  to  par- 
ticular persons  or  for  specific  goods  within  a  given  time. 

Bear  in  mind  that  cheques  are  not  a  legal  tender,  but  the  custom  of 
giving  them  has  now  become  so  firmly  established  that  few  persons  refuse 
genuine  ones  in  the  ordinary  course  of  business.  It  would  be  as  well  to 
say  a  few  words  here  regarding  the  use  of  cheques,  particularly  in  refer- 
ence to  restricting  the  negotiability  of  them,  as  this  is  a  subject  of  which 
the  average  man  knows  comparatively  little,  and  one  which  he  should 
fully  understand,  for  he  probably  adopts  the  practice  in  some  way  or 
other  very  frequently. 

A  "cheque"  may  be  defined  as  a  draft  or  order  for  money  payable  to 


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170  THB  DENTAL  DIGEST 

bearer,  drawn  on  a  banker;  or,  to  give  a  definition  in  legal  phraseology, 

it  is  an  order  upon  a  bank  by  a  customer  requesting  the  bank  to  pay  a 

sum  of  money  on  demand  to  the  person  named,  or  to  his  order,  or  to  the 

bearer  of  the  cheque.    Note  the  last  few  words  of  this  definition  very 

carefully,  as  they  carina  greajid^  pf  meaning.    The  request  to  the  bank 

is  to  pay  the  amount  *td  th^p^slW  haffted,  or  to  his  order,  or  to  the  bearer 

W*  th*e»clie(itfe..*Yo!UJ\Aft  ieflierfberithit  tbeJjisuaJrcieque  form  runs, 
•     •    ••••     •    ••    ••«•••      ••••••■••   ••••••• 

*'Pay  .*..*..*.*.*.**  or*  beaief.''"  The 'drawer*  iS  dt'perf^ct  liberty  to  place 
in  the  irfteryejiijifcjBpaDoe  a  nurnbftr,:tha>najiiO  of  any  person,  the  words 
'* self, "*^^ cash,''  of  any  omers'fie  i^she^aliffj'soTong  as  he  does  not  strike 
out  the  word  '^bearer,"  the  amount  is  payable  to  anyone.  K  the  word 
"bearer"  is  struck  out  and  "order"  written  above  it,  the  payee  (that  is 
the  person  in  whose  favor  the  cheque  is  drawn)  must  endorse  it.  Strictly 
speaking,  the  payee  should  authorize  the  bank  by  written  order  on  the 
back  of  the  cheque,  to  pay  the  money  to  a  third  party,  if  he  wishes  that 
done;  but  the  custom  has  become  firmly  established,  and  now  has  the 
force  of  law,  for  the  payee  to  merely  sign  his  name  on  the  back  (i.  e.,  to 
endorse).  Care  must  be  taken  to  see  that  the  endorsement  corresponds 
with  the  name  as  written  on  the  front.  If,  for  instance,  the  cheque 
is  drawn  in  favor  of  James  R.  Williams,  it  must  be  endorsed  that  way. 
It  may  be  that  the  payee's  correct  name  is  John  R.  Williams  (the  mistake 
being  on  the  part  of  the  drawer),  in  which  case  the  endorsement  should 
be  "James  R.  Williams,"  with  the  correct  signature  following  under- 
neath. In  such  cases,  however,  should  the  endorsement  not  be  exactly 
the  same  as  on  the  front,  the  bank  may,  of  its  own  knowledge,  be  sure 
that  the  cheque  has  passed  into  the  right  hands  and  may  certify  to  that 
effect  by  writing  under  the  signature  "endorsement  satisfactory,"  and 
then  either  pay  it  if  drawn  on  that  office,  or  else  forward  it  to  its  destina- 
tion. The  same  conditions  apply  if  the  word  "bearer"  is  struck  out 
without  writing  "order"  above.  It  is  obviously  wrong,  as  is  sometimes 
done  by  inexperienced  persons,  to  draw  a  cheque  in  favor  of  a  number  or 
anything  in  abstract  terms,  and  strike  out  "bearer,"  as  in  such  case  no 
endorsement  can  be  required. 

There  is  one  point  in  connection  with  the  matter  which  must  not  be 
overlooked.  Many  people  think  that  if  they  draw  a  cheque  in  favor  of  a 
person  and  strike  out  "bearer,"  it  devolves  upon  the  bank  to  be  satisfied 
that  the  endorsement  is  actually  the  signature  of  the  payee,  thus  being 
assured  that  the  cheque,  at  least,  had  passed  through  his  hands.  That  is 
not  so.  In  New  South  Wales,  at  all  events,  if  the  endorsement 
purports  to  be  the  same  as  on  the  face,  the  banker  is  justified  in  paying 
the  cheque;  in  other  words,  if  the  cheque  is  drawn  in  favor  of  E.  C. 
Forsathe  and  "£•  C.  Forsathe"  appears  on  the  back  of  it  when  presented 


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"JOSH"  COMES  BACK  171 

for  payment,  the  banker's  responsibility  ends  there.  There  is  con- 
siderable protection  in  the  system,  however,  inasmuch  as  if  anyone  has 
come  by  the  cheque  dishonestly,  and  writes  the  payee's  name  on  the 
back,  he  is  guilty  of  forgery,  and  will  be  dealt  with  accordingly. 

Should  a  cheque  be  stolen  the  owner  will  naturally  make  all  the 
eflFort  he  can  to  recover  it;  but  if  it  has  passed  into  the  hands  of  an 
innocent  holder  who,  in  the  course  of  legitimate  business,  has  given  value 
for  it,  that  holder  can,  as  I  have  indicated  previously,  insist  upon  pay- 
ment to  himself  by  the  bank,  provided  the  cheque  is  properly  drawn  and 
otherwise  in  order  when  presented. — The  Australian  Journal  of  Dentistry, 


"JOSH"  COMES  BACK 


Below  we  reproduce  answers  we  have  received  to  the  article  which 
appeared  last  month  and  was  signed  'Country  Dentist"  in  which  the 
Podunk  individual  says,  **What  are  you  going  to  do  when  they  say 
they  can  get  crowns  from  the  other  fellow  for  $5.00?  "  Read  this  answer; 
it's  worth  the  time. 

TO  "country  dentist" 

I  am  practising  in  the  country  and  I  formerly  '^charged  them  at  the 
gate."  I  did  a  big  business;  the  rough  necks  and  K.  M.'s  were  all  for 
me  and  they  loudly  sang  my  praises.  At  the  end  of  each  year  of  this 
kind  of  practising  I  found  that  there  was  very  little  left  for  "doc"  after 
the  bills  had  been  paid. 

Little  "Doc  Fist"  across  the  street  still  puts  on  his  bridge  work  at 
four  dollars  per,  but  I  have  changed  my  plan  of  doing  business  entirely 
and  I  do  not  have  time  to  worry  about  the  fellow  practitioner.  There 
is  not  a  set  fee  in  this  office  and  all  work  is  priced  from  the  minimum  up, 
with  the  accent  very  decidedly  on  the  up.  The  first  thing  that  is  dis- 
cussed when  the  patient  enters  the  office  is  the  fee,  and  of  course  the 
service  is  rendered  according  to  the  fee.  There  are  plenty  of  people  in  a 
country  town  who  will  pay  a  fee  that  will  entitle  them  to  receive  real 
dental  work,  but  it  is  a  question  of  salesmanship  and  enlightening  them 
along  the  line  of  the  different  methods  of  doing  this  work.  Use  sample 
work  and  with  this  work  use  some  salesmanship.  No  sane  person  would 
expect  you  to  place  a  cast  crown  for  the  same  price  as  a  plier  crown  made 
in  twenty  minutes.  This  holds  true  of  your  operative  work.  Of  course 
you  can  "put  in  a  silver  filling"  and  let  them  slip  you  a  dollar,  or  you  can 
discuss  this  matter  with  the  patient  before  the  operation,  and  quite  likely 
you  make  an  amalgam  restoration  for  three  dollars.    Ignorance  of  the 


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172  THE  DENTAL  DIGEST 

laity  causes  the  trouble  with  the  fee  question  and  it  is  not  so  much  the 
fault  of  the  "fellow  across  the  street."  Try  it,  doctor,  it  won't  do  any 
harm  to  tell  them  that  you  can  give  them  something  better  for  more 
money.  Amalgam  properly  placed  and  polished  is  worth  more  than  a 
dollar  and,  honestly,  that  is  about  the  only  reason  so  much  of  the  amalgam 
is  not  polished  and  properly  finished.  Get  the  flat  fee  out  of  your  head. 
I  do  not  wish  to  pose  as  a  braggard  and  do  not  wish  to  do  any  vain- 
glorious boasting,  so  the  editor  will  allow  me  to  sign  "Josh." 

Curtis,  Neb.,  Jan.  i,  1916. — Dr.  J.  M.  Prime,  Omaha,  Neb. — ^Dear 
Doctor:  I  can  not  help  but  comment  on  what  the  "Country  Dentist" 
has  to  say  in  regard  to  fees.  He  wants  to  know  how  to  get  more  than 
$5  for  a  crown,  when  his  competitor,  or  colleague  rather,  gets  $5.  Then, 
after  he  asks  how,  he  turns  around  and  says  it  can  not  be  done.  He 
don't  care  who  says  so.  He  reminds  me  of  the  Irishman  who  went  to 
the  circus  to  see  a  camel.  He  had  heard  about  them,  but  had  never 
seen  one.  When  he  saw  it  he  turned  to  Pat  and  said,  "Oh,  hell,  there 
ain't  no  such  animal  as  that." 

It  evidently  seems  that  this  country  dentist  is  in  a  rut  and  is  destined 
to  stay  there  until  the  cows  come  home.  Some  day,  though,  he  may 
wake  up  and  some  one  may  be  able  to  show  him  wherein  he  is  wrong.  At 
this  time,  however,  it  would  be  a  waste  of  time  and  space. 

Yours  truly, 

L.  A.  Chamberlin. 

THE   COUNTRY    DENTIST 

My  Dear  Brother:  I  do  not  know  who  you  are,  but  truly,  I  want 
to  know  you.  Firstly,  I  shall  say,  "Let  there  be  light.  And  there  was 
light."  Secondly,  I  want  you  to  know  that  my  feeling  toward  any  man 
who  will  endeavor  daily  to  perform  an  impossibiUty  is  one  of  love  and 
pity.  Will  you  kindly  permit  me  to  know  you  that  I  may  have  the 
privilege  of  helping  you?  There  isn't  anything  in  my  heart  except  to  be 
of  service  to  my  fellow  brother. 

I  shall  expect  to  see  your  name  given  me  in  next  month's  Journal, 
after  which  I  shall  answer  your  questions  to  the  best  of  my  ability. 

Truly  and  sincerely, 

William  L.  Shearer. 

ANSWER   TO   country   DENTIST 

In  your  reply,  Mr.  Country  Dentist,  to  Dr.  Shearer's  article  in  Prac- 
tical Hints  in  the  November  Journal,  you  ask  what  you  would  do  when  a 
farmer  comes  in  your  office  and  wants  a  gold  crown  for  $5  when  your 


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"JOSH"  COMES  BACK  173 

charge  for  a  crown  is  $6  and  another  man  comes  in  and  wants  a  plate  for 
$io  when  your  price  is  $15. 

I  will  tell  you  what  I  would  do  and  what  I  do  do.  I  would  step  back 
and  look  Mr.  Farmer  square  in  the  eye  and  give  him  one  of  the  biggest 
talks  on  first  class  dentistry  he  ever  heard  and  I  would  tell  him  the 
difference  between  a  $5  tin  can  crown  made  from  some  faker's  die  plate 
and  a  real  sure  enough  crown  which  you  have  properly  fitted  around  the 
gingivae,  contoured  and  carved  to  occlusion,  and  nine  out  of  ten  he  will 
pay  you  your  price  and  be  a  booster  instead  of  a  knocker.  The  farmer  of 
to-day  is  not  the  farmer  of  yesterday  any  more  than  the  dentist  of  to-day 
is  the  dentist  of  yesterday,  and  they  are  willing  to  pay  for  anything  if 
they  are  not  being  held  up. 

After  you  give  Mr.  Farmer  this  talk,  go  into  your  laboratory  and  heave 
your  die  plates  out  of  the  window  (using  care  not  to  strike  the  head  of 
some  passerby)  and  get  to  work  and  make  good  your  talk  to  Mr.  Farmer 
and  show  him  the  difference  between  your  crowns  and  a  $5  crown.  If 
you  don't  happen  to  have  one  on  hand  you  will  usually  find  one  in  his 
mouth,  and  that  is  the  best  place  to  compare  them. 

Why  is  it  a  different  proposition  in  the  country  than  in  the  dty?  I'll 
tell  you.  It  is  because  most  of  us  don't  want  to  spend  the  time  to  talk 
to  these  people  and  tell  them  what  they  are  getting.  Most  people  want 
just  as  good  work  as  they  can  get  and  are  willing  to  pay  for  it  if  they 
think  they  are  getting  their  money's  worth.  Give  them  the  best  there  is 
in  you  and  they  will  stay  by  you.  If  you  are  not  giving  them  as  good 
service  as  they  can  get  elsewhere,  you  had  better  get  busy  and  prepare 
yourself  so  you  can,  or  some  of  those  young  fellows  will  come  in  and  walk 
away  with  the  bacon  while  you  sit  in  the  comer  of  your  office  pulling  on 
an  old  cob  pipe  saying,  "These  young  fellows  don't  know  anything." 
You  just  quit  knocking  and  get  busy. 

If  the  big  men  in  the  cities  can  do  these  things,  why  can't  we  be  big 
men  in  the  country?    We  CAN,  and  I  don't  care  who  says  we  can't! 

A  Brother  Country  Dentist. 
Nebraska  Denial  Journal 


lie 


'Smokers'  Patches"  in  the  Mouth. — ^Landouzy  describes  these 
as  consisting  of  whitish  lines  or  triangular  patches  extending  from  the 
juncture  of  the  lips  to  the  first  molar.  These  are  also  known  as  smoker's 
commissural  patches.  They  are  found  exclusively  in  syphilitics.  To- 
bacco is  merely  the  local  irritant  which  causes  the  patches  to  develop 
in  the  predisposed. — Presse  Medicate,  {Medical  Record.) 


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174  THE  DENTAL  DIGEST 


CORRESPONDENCE 

Editor  Dental  Digest: 

Will  you  kindly  ask  the  profession  the  following  questions  in  your 
next  issue.    I  am  looking  for  the  honest  ones,  the  sore  ones,  also  the  few 
I  am  sorry  to  say  are  the  fakirs. 
Dr.  Surgeon  Dentist: 

1.  What  is  meant  by  Ethical  Dentist? 

2.  Do  you  or  do  you  not  know  any  that  are  Ethical  in  the  real  sense 
of  the  word? 

3.  If  you  yourself  are,  then  will  you  show  at  least  one  hundred  of 
your  contracts  so  that  your  claim  may  be  disproved? 

These  questions  have  been  generated  through  the  several  debates  that 
appear  from  time  to  time  in  the  Digest  Advertising  vs.  Ethics  as  per- 
taining to  dentistry. 

C.  S.  L. 

REPLIES  TO  E.  S.  G.* 

Dear  Brother  E.  S.  G.: 

After  glancing  at  the  table  of  prices  you  receive  for  your  labor,  I  can 
readily  believe  they  are  the  "lowest  in  the  state,''  regardless  of  what  state 
you  are  in.  I  am  also  forced  to  believe  you  when  you  say  it  gives  you  **  no 
little  trouble."  However,  I  can't  sympathize  with  you  for  it's  all  your 
own  fault  and  not  the  "old  man's." 

I  can't  account  for  a  town  of  7,000  and  only  three  dentists  unless  it 
is  because  they  are  so  disgusted  with  50  cent  cleanings  and  fillings  that 
they  either  go  somewhere  else  for  their  work,  or  possibly  may  not  have  it 
done  at  all.  If  you  are  doing  fifty  cent  fillings  and  cleaning  you  have 
no  right  to  ask  more.     If  not,  you  have  no  right  to  do  it  for  that. 

Supposing  you  were  to  go  into  a  store  and  upon  being  told  the  price 
of  an  article  you  told  the  proprietor  you  could  get  it  cheaper  from  Rears 
and  Sanbrick.  Do  you  think  he  would  at  once  become  a  veritable  lick- 
spittal  and  get  on  his  knees  and  beg  you  to  take  the  goods  at  no  profit  just 
to  keep  your  patronage?  Would  you  have  much  respect  for  him  if  he 
did?    No,  I  think  not;  yet,  that  is  just  what  you  are  doing. 

The  thing  for  you  to  do  is  to  raise  the  standard  of  the  work  and  show 
them  the  difference,  then  you  won't  have  any  trouble  in  getting  a  fair 
price.  Do  your  work  your  best  and  charge  a  fair  price.  Don't  be  afraid 
to  talk  to  them,  but  make  them  see  that  they  get  just  what  they  pay  for, 
be  it  in  dentistry  or  fish-hooks. 

Probably  the  reason  your  people  don't  demand  a  sanitary  office  is 

•January  Digest,  page  27. 


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CORRBSPONDENCB  17S 

because  they  never  saw  one.    Let  yours  be  the  first  and  they  won't  be 
slow  to  reali^  the  advantages. 

Did  you  ever  hear  of  a  dentist  being  starved  out  because  his  prices 
were  too  high?  No,  No,  Brother!  this  is  what  you  really  hear.  They 
say,  '*He  is  all-fired  high  but  he  does  good  work  and  so  most  of  us  go  to 
him." 

One  more  point — about  that  stock  of  crowns.  Of  course  there  always 
will  be  men  who  do  business  that  way,  and  then  just  across  the  street 
there  will  be  men  more  conscientious  but  with  no  backbone  who  will  try 
to  compete  with  them  and  then  mourn  their  sad  plight.  You  are  no  bet- 
ter than  those  you  consider  your  competitors,  so  if  you  want  to  get  out  of 
the  old  man's  class  all  -'ou  have  to  do  is  to  brace  up  and  do  better  work 
and  charge  for  it. 

"Waste  not  your  hour,  nor  in  vain  pursuit 
Of  this  and  that  endeavor  and  dispute; 
Better  be  jocund  with  the  fruitful  grape 
Than  sadden  after  none,  or  bitter  fruit." 

F.  L.  K. 

Editor  Dental  Digest: 

Dr.  E.  S.  G.  in  the  January  Digest  has  my  sympathy.  We  have  a 
town  of  less  than  7,000  and  it  supports  8  dentists.  He  says  his  is  in  a 
town  of  7,000  and  3  dentists.  If  I  was  looking  for  a  location  I  would 
endeavor  to  locate  in  his  town  and  would  take  his  scale  of  prices  and 
multiply  them  by  three  just  for  a  starter,  for  in  a  town  of  that  size  there 
are  enough  that  would  pay  it.  Of  course  a  person  would  have  to  do  a 
great  deal  of  talking  at  the  chair,  but  I  would  also  start  a  dental  educa- 
tion campaign.  I  would  ask  the  other  dentists  to  enter  into  it,  in  giving 
talks  to  the  school  children  and  the  various  clubs.  If  they  would  not 
enter  into  it,  I  would  go  it  alone.  If  patients  ever  came  to  me  and  said 
they  could  get  an  amalgam  filling  for  50  per  cent,  where  I  charged  $1.50, 
I  would  shoot  it  back  at  them  so  quick  that  it  would  startle  them,  that 
they  can  go  out  and  buy  a  horse  for  $25  or  one  for  $125,  or  even  $500, 
and  if  they  wanted  a  $25  horse  go  to  him.  However,  there  is  no  limit  to 
the  number  of  arguments  that  can  be  brought  out.  E.  S.  G.  is  in  the 
heart  of  a  gold  mine  and  does  not  know  it.  If  I  were  he  I  would  go  to 
my  office  to-morrow  morning  (no  I  would  stop  and  do  it  now)  make  a 
resolution  to  make  or  break,  then  put  a  sign  in  front  of  my  chair  some- 
thing like  this  "Ask  my  prices  before  having  work  done  and  avoid  mis- 
understandings. Take  nothing  for  granted."  This  I  would  do  in 
justice  to  those  who  had  been  patronizing  me  and  knew  the  prices  I  had 
been  charging.  L.  L. 


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[This  department  is  in  charge  of  Dr. 
V.  C.  Smedley,  604  California  Bldg., 
Denver,  Colo.  To  avoid  unnecessary  de- 
lay, Hints,  Questions,  and  Answers  should 
be  sent  direct  to  him.]* 

Leaky  Vulcanizer. — Get  a  package  of  Dixon's  stove  polish:  shave 
off  a  teaspoonful  and  pulverize  it.  Mix  it  with  equal  parts  of  glycerine 
and  water.  The  mixture  should  be  about  the  consistency  of  cream. 
Paint  it  on  the  packing  of  the  vulcanizer  with  a  small  brush.  A  very  thin 
layer  is  usually  sufficient.  Repeat  when  necessary. — D.  W.  Barker, 
D.D.S.,  Brooklyn,  N.  Y. 

To  Improve  Gasoline. — Should  gasoline  not  work  well  in  blow-pipe, 
not  giving  a  brush-flame  on  account  of  exposure  to  air,  add  a  little  sul- 
phuric ether  and  see  the  life  it  gets. — C.  M.  Bremerman,  D.D.S.,  Cali- 
fornia, Mo. 

Rugae  on  Plates. — ^After  flask  is  opened,  wax  removed,  take  suit- 
able carving  instnmients  and  different  sizes  of  ball  burnishers,  and  carve 
rugae  on  plaster  in  the  half  containing  teeth.  Burnish  tin-foil  over  this, 
pack  and  vulcanize.  It  takes  only  a  few  minutes,  and  you  are  well 
repaid  for  your  trouble. — H.  L.  Entriken,  D.D.S.,  Enid,  Okla. 

To  Stop  a  Leaky  Vulcanizer. — Wet  rim  of  cup  with  water  and 
sprinkle  Wilson's  corega  freely  on  same.  Close  at  once.  This  is  my 
original  way  when  "necessity  was  the  mother  of  invention.'' — P.  C. 
CuRRAN,  D.D.S.,  La  Crosse,  Wis. 

To  Clean  a  Glass  Slab  of  Cement. — I  always  put  my  glass  slab 
when  through  with  (as  I  have  several)  in  a  bowl  of  water  and  it  remains 
therein  until  the  next  morning  when  I  take  my  plate  brush  and  put  glass 
under  water  faucet.  Cement  readily  comes  off  and  leaves  slab  in  fine 
condition.— Dr.  O.  B.  Shedd,  D.D.S.,  Weedsport,  N.  Y. 

To  Make  a  Two  Piece  Shell  Crown  Serve  as  Bridge  Abutment. 
— In  making  two  piece  shell  crowns  to  serve  as  bridge  abutments,  place 
seam  of  band  on  either  mesial  or  distal  surface  of  root  so  as  to  have  entire 
seam  included  in  solder  area  of  adjacent  dummy. — J.  E.  Ruzicka,  D.D.S., 
Plainview,  Neb. 

*ln  order  to  make  this  department  as  live,  entertaining  and  helpful  as  possible,  questions 
and  answers,  as  well  as  hints  of  a  practical  nature,  are  solicited. 


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PRACTICAL  mNTS  177 

To  Facilitate  Waxing  Parts  of  Broken  Vulcanite  Plates 
Together. — Hold  parts  of  broken  vulcanite  plate  in  correct  apposition 
with  hands,  and  with  wax  spatula  in  mouth,  melt  wax  and  drop  with  piece 
of  tooth-pick  across  break. — N.  L.  Davies,  D.D.S.,  Seattle,  Wash. 

To  Do  Away  Altogether  with  the  Very  Much-Complained-of 
Bellows  to  a  Soldering  Outfit. — Get  a  small  rotary  air  pump  and 
fasten  it  to  the  wall  in  line  with  a  motor  (electric  or  water),  a  sewing 
machine  belt  to  transmit  the  power  if  an  electric  motor  is  used.  Place 
a  switch  near  the  blow-pipe  and  cut  in  on  the  line  so  when  it  is  turned  off 
the  motor  can  be  turned  to  first  speed;  to  start  fire  simply  turn  switch 
and  apply  match.  Am  using  it  with  a  gasoUne  generator  with  absolute 
success. — V.  C.  Stockberger,  D.D.S.,  Syracuse,  Ind. 

To  Grind  Natural  Teeth  Painlessly. — Much  of  the  discomfort 
in  the  use  of  stones  is  occasioned  by  the  jarring  or  vibration  of  the  stone 
against  the  tooth.  If  the  tooth  is  held  firmly  in  the  socket  or  against 
one  wall  of  the  socket  with  the  thumb  or  finger  of  the  left  hand  wliile 
grinding  down  enamel  or  opening  cavities  with  stones  it  will  minimize 
the  discomfort  immeasurably.  Of  course  it  is  understood  that  all  stones 
should  run  smoothly  and  true  and  that  a  stream  of  water  should  flow  on 
them  while  cutting.  If  these  precautions  are  taken,  any  ordinary  case 
of  grinding  can  be  done  painlessly. — E.  D.,  The  Denial  Review, 

To  Flow  Solder  Easily. — If  the  solder  is  cut  into  long  strips  instead 
of  short  pieces,  it  can  be  used  to  better  advantage.  Heat  the  case  up, 
and  taking  hold  of  one  end  of  the  strip  with  tweezers,  hold  the  other  end 
close  to  the  piece  to  be  soldered  and  direct  the  flame  on  it.  As  it  melts 
feed  it  down  into  the  joints  or  wherever  you  wish  it  to  flow.  In  this  way 
you  can  see  what  you  are  doing,  and  the  solder  may  be  fed  into  a  deep 
depression  or  built  up  into  any  desired  bulk  in  precisely  the  form  that  is 
required.  If  the  solder  is  not  flowing  properly,  dip  the  heated  end  of  the 
strip  in  powdered  borax,  and  this  will  flux  it  and  make  it  flow  smoothly. 
—J.  W.  J.,  The  Dental  Review, 

Root-Canal  Filling  Material. — Gutta-percha  base  plate,  weight 
one  half  ounce.  Saturated  solution  of  thymol  and  eucalyptol,  measure 
one  half  ounce.  Dissolve  gutta-percha  in  chloroform;  add  thymol  and 
eucalyptol  and  mix  thoroughly.  Allow  chloroform  to  evaporate.  Dry 
the  tooth  thoroughly  and  work  the  above  into  the  canals  with  a  warm 
broach,  forcing  to  apex  with  a  soft  piece  of  rubber  and  insert  gutta- 
percha point. — The  Pacific  Dental  Gazette. 

A  Porcelain  Jacket  Crown. — This  method  of  making  a  porcelain 
jacket  crown  is  as  follows: 


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178  THE  DENTAL  DIGEST 

First:    Remove  enamel  with  stones  and  burs. 

Second:  Take  impression  with  ferrule  containing  modeling  com- 
position. 

Third:    Fill  impression  with  cement. 

Fourth:  Take  bite  and  place  cement  model  in  bite  and  place  on 
articulator. 

Fifth:    Burnish  i-iooo  platinum  on  cement  model  of  end  of  tooth. 

Sixth:  Bake  porcelain  on  platinum  matrix. — G.  T.  Gregg,  D.D.S., 
The  Dental  Summary, 

Useful  Hints. — In  the  repair  of  vulcanite  there  is  no  need  of  waxing 
up  nor  using  the  press.  In  the  case  of  a  broken  plate,  grind  each  side 
of  the  fracture  one  quarter  inch,  very  thin  at  the  fracture,  and  pack  with 
hot  spatula,  rubbing  on  small  pieces  and  flask.  If  a  tooth  is  to  be  replaced 
hold  it  in  place  with  the  lingers,  having  filed  away  some  of  the  vulcanite 
and  pack  with  hot  spatula  and  flask. — ^L.  P.  Haskell,  The  Pacific 
Denial  Gazette, 

To  Restrict  the  Flow  of  Solder. — In  soldiering  gold,  when  it  is 
desired  to  restrict  the  flow  to  a  certain  area  with  a  sharp  lead  pencil 
draw  a  line  around  the  desired  area.  The  solder  will  not  flow  past  the 
line. — The  Dental  Register. 

Strengthening  Plaster  Models. — For  strengthening  thin  plaster 
models  so  that  they  can  withstand  the  pressure  exerted  in  flasking,  etc., 
light  and  thin  brass  wire  netting  as  employed  for  sieves  is  cut  to  suitable 
length  and  breadth  and  embedded  in  the  plaster  while  pouring.  To 
strengthen  a  bridge  abutment  on  a  plaster  model,  a  little  roll  of  wire 
netting  is  inserted  as  a  core  when  the  cast  is  being  poured. — ZahnaerzUiche 
Rundschau,  The  Dental  Cosmos, 

Separating  Modeling  Compound  Impressions. — In  taking  model- 
ing compound  impressions,  the  compound  may  easily  be  separated  from 
the  cast  if  the  impression  is  painted  with  a  thin  solution  of  shellac  before 
it  is  poured.  A  most  perfect  impression  may  be  obtained  if  the  compound 
be  vaselined  and  held  under  a  stream  of  hot  water  for  a  few  seconds  just 
before  the  impression  is  taken. — R.  Davis,  Dental  Review, 

To  Save  Time  and  the  Proper  Method  to  Repair  a  Plate. — If 
the  plate  is  cracked  two  thirds  of  the  way,  hold  together  until  crack  is 
closed,  then  with  sticky  wax  and  alcohol  flame  flow  sufficient  wax  over 
same  and  let  cool.  Then  make  plaster  model,  and  after  it  has  set  remove 
plate  and  break  in  two.  Take  fissure  bur  and  cut  \  inch  of  old  rubber  out 
of  each  side  of  break,  then  with  same  bur  cut  dovetail  grooves  on  either 
side  about  \  inch  apart,  then  wipe  clean  with  a  pledget  of  cotton  and 


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QUESTIONS  AND  ANSWERS  179 

chloroform.  Replace  parts  of  plate  on  model  being  sure  they  are  down 
where  they  fit  on  same.  Hold  same  with  left  hand  and  with  small  pieces 
of  rubber  and  a  clean  hot  spatula,  keeping  spatula  hot  with  alcohol  flame, 
proceed  to  work  rubber  into  grooves  until  even  with  surface  of  plate, 
then  stretch  another  piece  of  rubber  over  groove,  smooth  to  proper  thick- 
ness, and  the  whole  is  ready  for  flasking.  When  vulcanized  it  can  b^ 
finished  in  a  few  minutes.  I  repair  all  my  plates  in  this  manner.  A  new 
gimi  front  can  be  put  on  in  the  same  way.  The  plate  will  never  break 
where  the  new  rubber  has  been  inserted,  and  if  care  is  exercised  the  plate 
will  positively  undergo  no  change  to  cause  a  misfit. — ^Alfred  Frazer 
Kennedy,  D.D.S.,  Walter,  Okla. 

[I  approve  absolutely  of  this  method  of  making  repairs.  I  find  it 
imnecessary,  however,  to  cut  any  dovetails,  or  wipe  with  chloroform 
either  when  surfaces  receiving  new  rubber  are  freshly  cut  and  free  from 
wax  or  other  foreign  substance.  I  prefer  also  bridging  the  crack  with 
pieces  of  match  stick  held  with  sticky  wax  at  each  end,  putting  no  wax 
directly  upon  crack,  at  least  until  after  parts  are  firmly  held  in  place  by 
match  sticks,  permitting  one  to  turn  plate  over  examining  crack  from 
both  sides  to  see  that  it  is  correctly  closed.  In  hand  packing  repairs  in 
this  way,  it  should  be  kept  in  mind  that  spatula  must  be  as  hot  as  rubber 
will  stand  without  burning;  when  same  may  be  spread  on  like  butter; 
provided  the  right  kind  of  rubber  is  used.  I  find  Doherty's  maroon  about 
the  best  that  I  have  tried  for  this  purpose.  Black  rubber  can  scarcely  be 
used  for  this  purpose  at  all,  and  some  makes  of  maroon  and  red  are  not 
much  better.    V.  C.  S.] 


QUESTIONS  AND  ANSWERS 

Question. — ^Please  advise  the  best  way  to  make  a  duplicate  rubber 
plate  without  taking  another  impression.  (That  is,  put  new  red  and 
pink  rubber  in  plate).— H.  L.  R.,  Granton,  Wis. 

Answer. — Flow  as  much  wax  over  old  plate  as  you  think  you  will 
polish  off  in  finishing  new  rubber;  flask  case  just  as  you  would  if  it  were 
a  new  case,  all  wax.  After  plaster  has  set  thoroughly,  heat  up  very 
gradually  until  case  is  hot  enough  to  have  softened  old  rubber  somewhat, 
but  not  to  char  it.  Now  flask  may  be  opened  cautiously,  and  old  rubber 
taken  out;  some  of  the  teeth  may  stick  in  the  rubber,  but  these  can  be 
easily  removed,  placed  in  their  respective  places,  and  case  packed  as 
usual.  Impression  may  be  taken  inside  on  old  plate,  excess  of  impression 
material  trimmed  off,  and  a  re-adaptation  secured  as  above. — V.  C.  S. 


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THE  BLASTER 

in  ni  fi  in  T  by  b.  c.  forbes 

I  have  kaied  more  men  than  all  the  armies  of  the  world. 

I  have  blighted  more  homes  than  all  the  plagues  of  history. 

I  have  robbed  more  children  of  their  birthright  than  all  the  thieves 
ever  born. 

I  blast  careers. 

I  am  the  parent  of  untold  poverty. 

I  breed  diseases. 

I  spread  misery  wherever  I  go. 

I  am  oftentimes  the  inciter  of  the  recklessness  that  strews  the  world 
with  accidents  and  catastrophes. 

I  am  the  most  subtle,  the  most  insinuating,  the  most  alluring  of 
tempters. 

I  wear  the  guise  of  joy — of  happiness,  of  gaiety,  of  goodfellowship. 

I  promise  pleasures. 

I  deliver  death. 

I  charm  the  rich  as  easily  as  the  p>oor. 

I  am  embraced  by  the  educated  as  often  as  by  the  ignorant. 

I  speak  every  language. 

I  know  every  clime. 

I  am  as  old  as  history. 

I  am  mightier  than  kings  and  emperors. 

I  have  driven  rulers  from  their  thrones  and  overturned  dynasties. 

I  can  render  the  strongest  armies  imf)otent. 

I  can  sap  nations. 

I  rejoice  in  bringing  dishonor  and  degradation. 

I  fill  prisons. 

I  fill  insane  asylums  to  overflowing. 

I  feed  hospitals  with  patients. 

I  cause  more  divorces  than  jealousy  can  claim. 

I  am  equally  f)owerful  in  undoing  women  as  in  wrecking  men. 

I  am  welcomed  in  every  class  of  society. 

I  am  given  a  place  at  the  tables  of  the  most  cultured  and  the  most 
exclusive. 

I  am  as  eagerly  sought  after  by  the  poorest  and  the  most  ignor- 
ant. 


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DIGESTS  181 

I  am  so  prized  that  no  function  of  State,  no  brilliant  social  gathering, 
no  great  public  dinner  is  accounted  complete  without  my  presence. 

I  am  coveted  by  many  governments  for  the  revenue  I  yield  them. 

I  consume,  however,  more  wealth  than  has  been  spent  in  building  all 
the  railroads  and  all  the  steamships  of  the  world. 

I  am  the  costliest  inhabitant  in  every  nation. 

I  and  my  activities  call  for  the  expenditure  of  unreckonable  millions 
for  prisons  and  for  police  forces  and  courts,  for  hospitals  and  for  doctors 
and  for  nurses,  for  insane  asylums,  for  almshouses,  for  orphanages. 

I  am,  however,  beginning  to  be  seen  in  my  real  colors. 

I  am  being  subjected  to  scientij5c  investigation — and  found  wanting. 

I  am  falling  into  moral  disrepute. 

I  can  no  longer  fool  the  wise. 

I  have  received  a  body  blow  from  the  economic  regeneration  pre- 
cipitated by  the  war. 

I  have  been  discovered  to  be  the  arch-foe  of  progress,  of  strength,  of 
eflfort,  of  eflSdency. 

I  have  been  drummed  out  of  one  country  with  beneficent  results  which 
have  astounded  a  world  blind  to  my  real  character. 

I  have  been  curbed  in  another  empire  where  long  I  held  sway  among 
the  masses — ^men  and  women — impoverishing  them  grievously. 

I  have  been  barred  from  nineteen  States  in  this  great  commonwealth, 
but  though  many  believe  they  foresee  my  doom  from  end  to  end  of  the 
land,  I  still  have  many  powerful  friends  whose  pockets  I  fill  with  my  blood 
money,  but  whose  lives  and  families  I  wreck  sooner  or  later. 

I  have  all  the  forces  of  evil  on  my  side,  and  I  shall  fight  to  the  last 
ditch. 

I  can  prevail  so  long  as  I  am  allowed  to  wear  my  mask. 

I  cannot  hope  to  endure  for  a  day  if  I  be  revealed  in  all  my  real 
hideousness. 

I,  therefore,  summon  every  enemy  of  the  State,  every  enemy  of  the 
home,  every  enemy  of  family  life,  every  enemy  of  happiness,  every  enemy 
of  progress,  every  enemy  of  decency,  every  enemy  of  honor,  every  enemy 
of  health,  every  enemy  of  all  that  makes  life  worth  while — I  summon  all 
these,  my  supporters  and  my  worshippers,  to  enrol  themselves  under  my 
banner  of  skull  and  cross  bones  and  so  battle  for  me  that  I,  the  arch 
enemy  of  mankind  and  of  civilization,  shall  be  victorious  over  every 
agency  of  righteousness. 

Who  am  I? 

I  am  drink. — North  American. 


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182  THB  DENTAL  DIGEST 

OIL  OF  TURPENTINE  AS  A  HAEMOSTATIC 

By  G.  Grey  Turner,  M.S.Durh.,  F.R.C.S. 

A  severe  case  of  bleeding  after  an  operation  on  the  elbow  resisted  all 
treatment  until  the  wound  was  packed  with  gauze  soaked  in  oil  of  tur- 
pentine. The  haemorrhage  which  previously  had  been  severe  and  long 
continued,  at  once  ceased.  The  successful  use  of  the  oil  has  been  proved 
on  many  other  occasions.  Its  chief  sphere  of  usefulness  as  a  haemostatic 
is  in  cases  of  secondary  haemorrhage.  It  is  of  no  use  until  the  area  to  be 
treated  has  been  thoroughly  freed  from  blood  clot  and  d6bris;  and  it  is 
especially  valuable  in  those  cases  in  which  no  bleeding  point  can  be 
caught,  but  in  which  the  haemorrhage  is  nevertheless  alarming.  The  oil 
is  an  antiseptic,  and  gauze  saturated  with  it  keeps  wonderfully  sweet, 
while  by  its  action  on  the  living  tissues  it  gives  rise  to  a  slimy  pus  which 
greatly-  facilitates  the  removal  of  the  gauze  in  the  course  of  forty-eight 
hours.  The  only  local  inconvenience  to  which  it  may  give  rise  is  some 
blistering  of  the  skin,  which  need  not  occur  if  care  is  exercised  in  its 
application.  Its  use  is  not  limited  to  limbs;  for  bleeding  from  a  tooth 
socket  the  author  knows  of  nothing  that  is  its  equal.  Doubt  is  expressed 
as  to  the  value  of  oil  of  turpentine  as  a  haemostatic  when  taken  by  the 
mouth. — Lancet,  July  31,  1915. 

CONVERSATION 

A  dentist  of  my  acquaintance  who  attributes  a  large  measure  of  his 
success  to  his  punctilious  attention  to  the  "little  things"  prides  himself 
on  his  ability  to  taXkjusi  enough  to  his  patients. 

Not  so  much  as  to  bore  them  nor  so  little  as  to  make  the  silence 
oppressive.  Nothing  focuses  the  mind  of  the  patient  more  strongly 
upon  the  task  at  hand  than  sQence.  Nothing  makes  the  patient  long  to 
get  away  from  the  dentist's  oflSce  and  never  see  it  or  the  dentist  again 
more  than  too  much  trite  talk. 

As  in  most  things,  the  happy  mediimi  is  the  perfect  virtue. 

Talk  of  pleasant  things,  of  interesting  things.  Avoid  the  weather 
and  other  commonplace  topics  that  tend  to  boredom.  Study  the  inter- 
ests of  your  patients  where  possible  and  talk  about  them.  Talk  baseball 
to  the  boys,  political  or  business  conditions  to  the  men  and  affairs  of  local 
interest  to  the  women.  Be  up  on  current  events — a  good  newspaper 
will  keep  you  so — and  be  able  to  converse  easily  on  a  variety  of  subjects. 
Don't  overdo  the  matter,  know  when  not  to  talk,  and  don't  ask  questions 
when  your  patient's  mouth  is  occupied  with  hand  or  instrument. 

Greet  your  patient  with  a  smile,  talk  to  him  entertainingly,  but  not  too 
much,  while  he  is  in  the  chair  and  give  him  a  pleasant "  good-bye."  It  pays. 


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DIGESTS  183 

INFECTION  OF  THE  HANDS  AND  FINGERS  OF  PHYSICIANS 

Hddenhain  states  that  during  thirty-one  years  in  which  he  has 
practised  surgery  he  has  been  injured  innumerable  times  and  in  all  cus- 
tomary ways,  in  the  course  of  operation  on  subjects  with  sepsis  and  had 
never  once  become  infected.  He  began  after  a  while  to  regard  himself 
as  inunime.  However,  with  a  rich  experience  he  had  never  seen  a 
surgical  infection  in  any  colleague  or  assistant  in  his  own  sphere  of  in- 
fluence. Nevertheless  he  has  seen  numerous  infections  in  surgeons  from 
other  clinics.  The  author's  only  prophylactic  after  an  injury  was  to 
keep  the  hand  and  arm  in  complete  rest  for  twenty-four  to  forty-eight 
hours.  Once  a  colleague  came  to  him  for  a  dressing  for  an  autopsy 
woimd,  and  he  ordered  immobilization.  Returning  from  an  absence 
of  several  days  he  found  the  man  dead.  He  had  removed  the  dressing 
and  very  soon  after  experienced  a  chill.  The  author  believes  firmly  that 
immobilization  for  forty-eight  hours  after  these  traumatisms  would 
result  in  a  great  reduction  of  morbidity  and  mortality  among  surgeons. 
At  the  last  moment  the  author  had  a  most  corroboratory  test  of  his 
theories  in  his  own  person.  After  one  day's  immobilization,  following  an 
injury  he  felt  it  his  duty  to  do  a  certain  amoimt  of  typewriting.  He  soon 
developed  a  chill  and  local  infection  which  laid  him  up  for  a  month  and 
caused  him  much  misery.  He  was  fortimate  in  escaping  a  general 
infection. — MUnchener  medizinische  Wochenschrift  {Medical  Record) 

EXTRAGENITAL  CHANCRES 

Henry  Kennedy  Gaskill  says  it  is  manifestly  impossible  to  determine 
with  any  degree  of  accuracy  the  comparative  frequency  of  extragenital 
chancres.  The  only  place  in  which  this  could  be  approximately  estimated 
would  be  in  the  army  and  navy;  here  careful  statistics  of  all  venereal 
diseases  are  made  and  the  utmost  care  is  taken  to  prevent  their  con- 
traction. Unless  there  is  a  well-maintained  correlation  between  the 
several  departments  that  treat  syphilis  the  value  of  statistics  is  entirely 
lost.  As  a  rule  in  the  histories  of  cases  recorded  as  having  been  treated 
no  reference  is  made  to  the  situation  of  the  chancres.  The  writer  thinks 
we  are  prone  to  minimize  the  danger  to  which  doctors  and  dentists  are 
subjected,  particularly  the  latter.  With  the  modem  ideas  of  antisepsis, 
the  dentists  of  to-day  are  sterilizing  each  instrument  after  every  patient, 
but  this  does  not  mitigate  the  risk  of  personal  inoculation!  For  their 
own  sakes,  dentists  should  be  trained  to  recognize  the  appearance  of  the 
mucous  patch  while  in  college.  At  present,  to  a  very  large  extent,  they 
obtain  their  information  only  from  books,  and  colored  plates,  not  from 
living  patients. — New  York  Medical  Journal, 


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184  THE  DENTAL  DIGEST 

AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL 
LITERATURE 

[The  Dental  Review,  February,  1916] 
Original  Communications 

What  Shall  We  Do  with  Pulpless  Teeth.    By  Thomas  B.  Hartzell. 
•The  Treatment  of  Sinuses  of  the  Head  by  Means  of  Bismuth  Paste.    By  Emil  G.  Beck. 
A  Consideration  of  the  Problems  Involved  in  Removable  Bridge  Work.    By  Karl  G. 

Rnoche. 
President's  Address.    Our  Opportunity.    By  W.  C.  M'Wethy. 

Proceedings  of  Societies 

Minnesota  State  Dental  Association,  Thirty-second  Annual  Meeting,  Held  at  Minneapolis, 

June  II,  12,  1915. 
Odontological  Society  of  Chicago. 
Chicago  Dental  Society. 
Northern  Illinois  Dental  Society,  Twenty-eighth  Annual  Meeting,  Held  at  Freeport,  Illinois, 

October  20,  21,  1915. 

Editorial 
The  Widening  Sphere  of  Dental  Journalism. 

Editor's  Desk 

Answer  Your  Letters. 

THE  TREATMENT  OF  SINUSES  OF  THE  HEAD  BY  MEANS  OF  BISMUTH  PASTE* 
By  Emil  G.  Beck,  M.  D.,  Chicago,  III. 

Practically  all  sinuses  are  preceded  by  abscesses,  and  therefore  a 
sinus  is  nothing  else  than  a  shriveled  abscess  cavity.  Many  believe  that 
sinuses,  especially  rectal,  are  channels  caused  by  pus  burrowing  through 
narrow  spaces  from  one  part  of  the  body  to  another.  I  am  convinced 
that  a  sinus  starts  from  an  infection  in  either  the  bony  structure  or  the 
parenchymatous  organs  and  after  the  formation  of  an  abscess,  the  pus 
spreads  in  the  direction  of  least  resistance  and  opens  into  either  the  skin 
or  the  bowels,  the  urinary  bladder,  or  even  the  gall-bladder.  After 
evacuation  the  cavity  gradually  shrinks  and  the  sinus  forms. 

When  the  abscesses  spread  in  various  directions,  they  form  multi- 
locular  abscesses,  sometimes  communicating,  and  at  other  times  not,  so 
that  an  astonishing  network  of  sinuses  may  result.  This  fact  was  not 
known  until  it  was  demonstrated  by  radiograms  of  the  injected  sinuses. 

♦Read  before  the  Odontological  Society  of  Chicago,  October,  iqij;. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     185 

"The  method,  as  you  know,  consists  of  injecting  with  a  glass  or  metal 
syringe  a  quantity  of  bismuth  paste  into  an  opening  of  a  sinus  until  one 
feels  reasonably  certain  that  all  ramifications  have  been  filled.  The 
paste,  thus  injected,  will  rapidly  congeal  and  remain  in  the  sinuses  long 
enough  to  permit  of  taking  a  radiograph. 

"A  glance  at  the  radiographs  in  which  the  network  of  tortuous  sinuses 
is  clearly  shown  teaches  us  its  advantages.  We  can  all  recall  instances 
in  which  such  a  radiograph  would  have  been  of  great  assistance,  and 
would  have  spared  many  an  unfortunate  a  useless  operation. 

"Formerly  we  had  to  rely  upon  the  probe  or  the  colored  fluids  as 
pathfinders  of  sinuses,  but  these  served  as  guides  during  the  operation, 
while,  only  with  this  new  method,  are  we  able  to  make  a  correct  ana- 
tomical diagnosis  before  an  operation  is  decided  upon,  and  thus  we  are 
able  to  discriminate  between  operable  and  non-operable  cases. 

"If  an  operation  is  decided  upon,  then  the  procedure  is  carried  out 
with  more  thoroughness  and  precision,  as  we  can  work  with  definite 
plans  before  us." 

Suppurative  sinuses  about  the  jaws  very  often  communicate  with  the 
cavities  of  the  accessory  sinuses.  Here  they  are  not  nearly  so  extensive 
as  elsewhere  in  the  body. 

Sinuses  frequently  follow  injury,  such  as  gunshot  wounds  and  frac- 
tures. Another  type  is  from  postoperative  infections,  after  drainage,  or 
even  after  clean  operation. 

Surgical  operations  for  sinuses  in  the  past  have  proven  very  un- 
satisfactory. In  my  brother's  and  my  series  of  some  i,8oo  cases 
treated  with  bismuth  injections,  there  were  some  which  had  lasted  many 
years  and  had  resisted  all  surgical  treatment;  one  case  had  lasted  sixty 
years,  two  others  forty  years.  Since  the  introduction  of  bismuth  paste, 
we  have  been  able  to  separate  the  operable  from  the  inoperable  cases 
atnd  thus  avoid  useless  operations.  The  majority  of  the  cases  thus 
treated  heal  up  without  surgical  invention.  Sixty  per  cent,  have  gotten 
well. 

WHAT  SHALL  WE  DO  WITH  PULPLESS  TEETH? 

By  Thomas  B.  Hartzell,  M.D.,  D.M.D. 

Research  Professor  of  Mouih  Infections^  School  of  Medicine;  Professor  of  Oral  Surgery  and 

Clinical  Pathology,  College  of  Dentistry 

First  and  foremost,  is  the  sterile  well-filled  tooth  a  menace?  My 
answer  to  that  question  is  most  emphatically,  no.  However,  the  pulp- 
less  tooth  of  the  future  must  be  handled  by  vastly  diflferent  methods 
than  the  methods  of  the  past  to  escape  condemnation.    We,  as  a  pro- 


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186  ,THE  DBHTAL  DIGEST 

fession,  will  have  to  give  to  the  care  of  the  pulpless  tooth  or  the  tooth  to 
be  devitalized,  hours  of  time,  where  in  the  past,  we  have  slurred  it  over 
with  little  consideration.  To  accurately  remove  the  pulp,  where  re- 
moval is  possible,  and  fill  and  protect  root  canals  of  a  molar,  means  the 
work  oftentimes  of  two  or  three  hours,  and  to  remove  root  filling  from  an 
imperfectly  filled  root  and  purify  and  re-fiU  the  canals,  may  involve 
double  that  expenditure  of  time.  The  question  which  confronts  us  is, 
are  we  willing  to  educate  our  patients  to  the  need  of  this  work  and  do  it 
in  such  a  manner  as  to  protect  them  from  serious  damage?  If  we  are  not, 
we  must  face  the  issue  which  is  extraction  for  all  teeth  in  which  decay 
has  exposed  the  pulp  to  infection.  For  that  other  type  of  case,  in  which 
bridge  work  must  be  placed,  we  are  confronted  by  the  necessity  for  apply- 
ing bridges  to  our  teeth  in  such  a  manner  that  the  pulps  may  be  preserved. 
I  here  present  for  your  study  a  common  example  in  which  a  crown  has 
been  placed  upon  a  vital  tooth,  which  subsequently  died.  Some  of  the 
worst  cases  of  infection  that  it  has  been  my  fortune  to  see  have  resulted 
from  the  death  of  teeth  which  were  not  devitalized  previous  to  crowning. 
The  presence  or  absence  of  abscess  depends  upon  two  things  primarily, 
the  admission  of  micro-organisms  to  the  tissues  and  the  decrease  of 
resistance  of  the  individual  who  has  long  been  sensitized  to  them  by 
absorption  of  their  poisons  into  the  circulation  from  some  focal  point 
or  their  constant  ingestion  in  the  saliva.  The  recorded  cases  of  the 
speaker,  of  vital  teeth  showing  abscess  for  two  years,  and  of  C.  J.  Grieves 
of  Baltimore  for  one  year  is  fifty  vital  teeth  showing  abscess. 

During  the  past  winter  I  have  noted  thirty  cases  of  teeth  which  were 
bearing  crowns,  which  teeth  had  subsequently  died  as  the  result  of  in- 
fection and  extra  stress  placed  upon  them  in  bridges.  Infections  re- 
sulting from  death  of  pulps  under  bridges  always  cause  the  loss  of  the 
bridge,  whereas  roots  from  which  the  pulps  have  been  removed  and 
properly  treated  from  the  standpoint  of  asepsis,  which  undergo  the  mis- 
fortune of  abscess,  frequently  may  be  saved.  It  seems  to  me  that  we 
should  all  endeavor  to  perfect  ourselves  in  a  method  or  methods  which 
will  lead  to  few  infections  through  the  dental  path.  In  other  words, 
close  the  door  to  infection. 

I  have  record  of  one  hundred  and  fifty  teeth  which  were  found  to 
contain  dead  pulps  which  teeth  were  perfect  as  to  their  structure,  pre- 
senting no  decay  or  abrasion,  the  death  of  the  pulps  having  been  produced 
by  some  influence  not  known  to  the  patient.  I  have  also  record  of  and 
can  show  you  a  lantern  slide  of  teeth  that  are  apparently  abscessed,  pre- 
senting a  clear  area  of  rarefaction  about  the  root  ends  which  contained, 
when  examined,  vital  pulps.  In  fact,  I  have  two  recent  cases  in  which 
we  have  large  abscesses  involving  a  lateral  and  central,  which  in  operat- 


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AN  EPITOME  OF  CURREHT  DENTAL  AND  MEDICAL  UTERATURE    187 

ing  to  shell  out  the  abscess  sack,  exposed  both  the  central  and  lateral 
root  tips  leaving  them  standing  in  view,  the  central  containing  a  living 
pulp  in  seemingly  good  health  with  the  pulp  of  normal  color  and  vital. 
Therefore,  we  have  evidence  to  show  that  the  focus  of  infection  about 
teeth  does  not  necessarily  depend  upon  destruction  of  the  pulp  itself. 
The  one  hundred  and  fifty  devitalized  teeth  just  mentioned  doubtless 
were  devitalized  by  the  admission  into  the  circulation  of  the  pulps  of 
bacterial  emboli.  Possibly,  as  most  of  them  were  abscessed,  the  abscess 
commenced  in  the  apex  of  the  socket,  because  the  apex  of  the  socket  is 
the  most  likely  place  for  bacterial  emboli  to  lodge  whether  the  tooth  be 
vital  or  non-vital.  The  anatomical  relations  favor  the  deposition  of 
bacterial  emboli  in  the  apices  of  the  tooth's  socket  because  some  of  the 
vessels  there  are  terminal.  If  bacterial  emboli  lodge  and  multiply  in  the 
terminal  vessels,  which  supply  the  tissues  about  a  root  end,  the  result  is 
abscess  whether  the  tooth  be  vital  or  pulpless. 

[The  Dental  Cosmos,  February,  1916] 

Original  Communications 

Mottled  Teeth:  An  Endemic  Developmental  Imperfection  of  the  Enamel  of  the  Teeth 
Heretofore  Unknown  in  the  Literature  of  Dentistry.     By  G.  V.  Black,  M.D.,  D.D.S. 
Sc.D.,  LL.D.,  and  Frederick  S.  McKay,  D.D.S. 
The  Treatment  of  Pyorrhea  Alveolaris  with  Emetin  Hydrochlorid.    By  Lionel  SherrifiF, 

Suigical  Dentist. 
♦Ankylosis  of  the  Jaw.    By  John  B.  Murphy,  M.D.,  F.R.C.S.  (Eng.),  F.A.C.S.,  and  PhQip 

H.  Kreuscher,  A.M.,  M.D. 
•The  Mercurial  Treatment  of  Pyorrhea  Alveolaris.    By  C.  S.  Copeland,  D.D.S. 
•A  Further  Study  of  Some  Etiolo^  cal  Factors  of  Malocclusion.    By  Milo  Helhnan,  D.D.S. 
Some  Considerations  for  the  Dental  Practitioner  in  Employing  Vaccine  Treatment.    By 

George  C.  KQsel,  M.D.,  D.D.S. 
The  Uses  and  Advantages  of  X-rays  as  an  Aid  to  Diagnosis.    By  Charles  A.  Clark,  L.D.S.I. 
A  Comparison  of  Inkys  with  Fillings.    By  H.  W.  C.  Badecker,  B.S.,  D.D.S.,  M.D. 

ANKYLOSIS  OF  THE  JAW 
By  John  B.  Muhfhy,  M.D.,  F.R.C.S.  (Enc.)  FJV.C.S., 

AND 

Philip  H.  Kreuschek,  A.M.,  M.D.,  Chicago 

This  analysis  of  twenty-three  cases  covers  the  four  varieties  of  anky- 
losis that  occur  in  or  about  the  temporo-mandibular  articulation,  viz. : 

(a)  Intra-articular  bony  ankylosis. 

(b)  Intra-articular  fibrous  ankylosis. 

(c)  Sub-zygomatic  cicatricial  fixations. 

(d)  Inter-alveolar  buccal  fixations. 

The  technique  for  the  formation  of  new  joints  may  be  divided  into 


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188  THE  DENTAL  DIGEST 

seven  diflferent  stages,  each  of  which  has  been  initiated  or  created  by  the 
work  of  a  single  individual  and  followed  by  the  succeeding  schools.  These 
stages  are: 

(i)  The  formation  of  flail  joints,  especially  of  the  shoulder  and 
elbow  (Langenbeck,  Oilier,  Julius  Wolff,  and  others).  These  were  de- 
sired sequences  following  resections  of  tuberculous  and  syphilitic  joints, 
and  joints  destroyed  by  pus  infections. 

(2)  The  restoration  of  motion  in  a  bony  ankylosed  joint  by  the  inter- 
position of  muscle  and  fibrous  tissue  between  the  separated  ends  at  the 
joint,  as  in  the  mandible  (Helferich,  1893). 

(3)  False  joints  developing  after  bone  operations  in  the  neighborhood 
of  joints  (Lorenz). 

(4)  The  transplantation  of  pedicled  flaps  of  fascia  and  fat  and  capsule 
with  the  production  of  movable  sliding  serous  surface  joints  (Murphy, 
1902)  in  the  mandible,  shoulder,  elbow,  wrist,  finger,  hip,  knee,  ankle,  and 
toe  articulations. 

(5)  The  homo-transplantation  of  the  articular  ends  and  surfaces  of 
bone  (Lexer,  1906),  particularly  in  the  knee. 

(6)  The  transplantation  of  detached  fat  and  fascia  (Lexer). 

(7)  The  interposition  of  foreign  material  to  make  the  joint,  from 
Pean's  metallic  joint  down  to  Kraske,  Baumgarten,  Roser,  and  Baer's 
hetero-visceral  implantations. 

The  fourth  stage,  as  outlined  by  Murphy,  is  a  transplantation  of 
pedicled  flaps  of  fascia  with  fat  and  capsule.  It  is  the  one  which  has 
given  practically  one  hundred  per  cent,  movable  joints,  and  is  applicable 
in  nearly  every  joint  of  the  body  where  the  peri-articular  tissues  have 
not  been  destroyed  by  some  previous  operative  procedure  or  destructive 
pathologic  process.  It  would  be  gratifying  if  the  free  fascia  and  fat 
transplantation  of  Lexer,  mentioned  under  stage  6,  would  with  future 
experience  sustain  the  good  results  which  its  originator  predicts  for  it. 
Judging  from  our  experience  we  believe  that  it  will  not  meet  the  require- 
ments in  weight-bearing  joints. 

The  insertion  of  foreign  material  or  heteroplasties  are  doomed  to 
disappear  from  this  field  of  work,  as  experience  has  shown  that  foreign 
absorbable  material,  if  aseptic,  must  eventually  be  supplanted  by  con- 
nective tissue;  while  a  flexible  flail  joint  may  result,  a  movable  sliding 
joint  cannot  be  obtained  from  such  an  interposition.  The  foreign  ma- 
terial, when  it  is  septic,  is  always  a  detriment  rather  than  an  aid  in  the 
formation  of  a  movable  joint.  Non-absorbable  metal  materials  can 
be  serviceable  only  under  very  few  favorable  conditions.  (See  Chlum- 
aky's  experiments.) 

In  Murphy's  work  on  the  arthroplasties  of  the  temporo-mandibular 


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AN  EPITOMB  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    189 

articulation  the  cases  may  be  divided  as  stated  above,  viz:  (a)  The 
intra-articular  bony  ankylosis  (true  ankylosis);  (b)  the  intra-articular 
fibrous  ankylosis;  (c)  sub-zygoma  tic  cicatricial  fixations,  and  (d)  inter- 
alveolar  buccal  fixations. 

Under  c  belong  the  fixations  in  the  sub-zygomatic  zone,  resulting  in 
scar  tissue  which  binds  the  coronoid  process  to  the  cranium.  Under  d 
belong  the  cicatricial  fixations  due  to  sloughing  of  muscle  and  mucosa 
in  the  mouth  or  cheek. 

ROUTES   OF  INVASION 

The  four  routes  of  infection  invasion  into  or  surrounding  the  temporo- 
mandibular articulation  may  be  given  thus: 

First,  and  most  frequent:  An  extension  of  the  suppuration  from  the 
middle  ear  (cases  No.  i.  No.  4,  No.  7). 

Second:  A  mandibular  osteitis  or  osteomyelitis  extending  to  the 
glenoid  cavity. 

Third:  A  metastasis  from  foci  of  infection  within  the  mouth  or  else- 
where in  the  body  (cases  No.  2,  No.  3,  No.  9,  No.  10,  No.  19,  No.  20), 
or  part  of  a  general  metastatic  arthritis  (case  No.  11). 

Fourth:  It  may  result  from  a  transmitted  trauma  from  the  tip  of 
the  chin  to  the  articulation,  giving  a  traumatic  osseous  fibrous  arthritis 
(cases  No.  6,  No.  14,  No.  15,  No.  17). 

The  glenoid  fossa  alone  may  be  involved  in  the  ankylosis,  or  the  bony 
bridge  may  extend  forward  to  include  the  zygomatic  and  coronoid  pro- 
cesses. 

The  most  common  cause  of  the  ankylosis  is  a  middle-ear  suppuration 
in  which  the  infection  may  pass  in  five  different  directions:  First,  back- 
ward into  the  mastoid;  second,  through  the  posterior  wall  of  the  petrous 
bone  into  the  posterior  cerebral  fossa;  third,  it  may  penetrate  the  attic 
of  the  ear  and  form  an  abscess  in  the  middle  cerebral  fossa  or  rupture 
externally  just  above  the  tip  of  the  ear;  fourth,  it  may  burrow  forward 
and  rupture  into  the  glenoid  cavity  or  pass  over  the  base  of  the  zygomatic 
process  into  the  mandibular  articulation;  fifth,  it  may  burrow  forward 
into  the  sub-zygomatic  temporal  muscle  and  produce  an  extensive 
phlegmonous  myositis,  with  subsequent  cicatricial  contraction  binding 
the  coronoid  process  and  inhibiting  mandibular  motion. 

In  the  cases  of  para-articular  fixation  the  condition  is  usually  caused 
by  (i)  a  sloughing  of  the  mucosa  of  the  cheek,  such  as  follows  typhoid 
fever,  scarlet  fever,  measles,  infection  of  the  alveolar  processes;  (2)  in- 
fection of  the  scalp  or  cranium  or  infections  from  the  mouth  into  the 
temporo-mandibular  fossa  which  produce  a  destruction  of  the  fascia  and 
temporal  muscle. 


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190  THS  DENTAL  DIGEST 

A  FURTHER  STUDY  OF  SOME  ETIOLOGICAL  FACTORS  OF  MALOCCLUSION 

By  Milo  Hellman,  D.D.S.,  New  York,  N.  Y. 

(Read  before  the  Eastern  Association  of  Graduates  of  tke  Angle  School  of  Orthodontia,  at  Us 
annual  meeting,  New  York,  M-^ly  20,  XQ15) 

RiSUMfi 

Dr.  Hellman  sums  up  the  evidence  which  he  brings  forth  in  this 
article  as  follows: 

(i)  That  malocclusion  of  the  teeth  is  found  to  be  intimately  related 
to  conditions  that  interfere  with  normal  breast-feeding.  Of  134  cases 
examined,  83  per  cent,  were  found  to  be  bottle-fed. 

(2)  That  results  obtained  by  experimentation  demonstrate  that 
definite  anomalies  in  the  teeth  and  jaws  may  be  produced  in  lower 
mammals  by  artificial  disturbances  created  in  the  internal  secretory 
glands. 

(3)  That  a  close  relationship  is  found  to  exist  between  malocclusion 
of  the  teeth  in  the  human  being  and  such  anomalies  of  the  denture  as  are 
produced  by  experimental  disturbances  of  the  internal  secretory  ap- 
paratus. Of  149  cases  of  malocclusion  examined,  there  were  65  mal- 
formations in  the  enamel-covering  of  the  teeth;  19  anomalies  in  the 
size  and  form  of  the  teeth;  98  irregularities  in  the  shedding  of  the  decid- 
uous teeth,  and  in  irregularities  in  the  eruption  of  the  permanent  series. 

It  may  therefore  be  concluded  that  of  the  numerous  factors  that  enter 
into  the  etiologic  problem  of  malocclusion  of  the  teeth,  internal  secretion 
is  the  one  which  may,  in  a  large  measure,  account  for  many  mysteries 
that  perplex  the  orthodontist.  The  appreciation  of  the  paramount 
importance  of  this  factor  will  be  evident  in  proportion  as  more  knowl- 
edge is  gained  with  reference  to  the  profound  working  of  this  most  wonder- 
ful system  of  glands. 

THE  MERCURIAL  TREATMENT  OF  PYORRHEA  ALVEOLARIS 
By  C.  S.  Copeland,  D.D.S.,  Rochester,  N.  Y. 

The  nlany  "cures"  for  pyorrhea  alveolaris  which  have  been  presented 
to  the  dental  profession  during  the  past  few  years  have  demonstrated 
that  we  are  alive  to  the  importance  of  combating  this  dreadful  disease 
and  its  secondary  systemic  infections.  Each  has  had  its  fair  and  im- 
partial trial  and  been  found  wanting,  yet  each  has  contributed  its  small 
mite  to  the  process  of  elimination  and  to  the  survival  of  the  fittest. 
That  local  instrumentation  and  treatment  has  not  been  eliminated  in 
this  contest  is  conceded  by  all  contestants.  That  mercuric  sucdnimid 
properly  injected  and  combined  with  local  treatment  effects  a  cure  in  all 
but  hopeless  cases  I  have  demonstrated  to  my  complete  satisfaction. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     191 

Systemic  infections  secondary  to  pyorrhea  are  also  cured  by  this  treat- 
ment 

While  my  experience  and  investigations  with  this  mercurial  treatment 
have  been  limited  to  the  above  cases,  they  certainly  verify  the  reports 
of  Dr.  Wright  and  Dr.  White  of  the  Portsmouth  Navy  Yard.  To  those 
who  expect  a  few  injections  of  mercuric  sucdnimid  alone  to  cure  pyorrhea, 
let  me  again  emphasize  the  absolute  necessity  for  careful  local  instru- 
mentation and  treatment,  for  it  is  only  by  this  combination  that  such 
wonderful  results  have  been  obtained.  For  the  benefit  of  those  who  do 
not  understand  the  technique  of  mercurial  injections,  it  is  described  here 
in  full,  just  as  I  saw  it  carried  out  by  Dr.  Wright  while  at  the  Portsmouth 
Navy  Yard.  This  technique  is  simple  and  easily  mastered,  and  as  all 
dentists  have  the  legal  right  to  administer  any  and  all  of  the  drugs  in 
the  pharmacopoeia,  either  locally  or  systemically,  there  is  absolutely  no 
reason  why  they  should  not  make  their  own  injections.  In  the  case  of 
female  patients,  only  a  small  area  need  be  exposed,  the  rest  of  the  body 
being  draped  with  sheeting  by  an  assistant. 

TECHNIQUE 

The  syringe  used  is  made  by  Burroughs,  Wellcome  &  Co.,  all  glass, 
and  holding  forty  minims.  The  needles  used  are  No.  26,  intra-muscular, 
for  the  above  syringe. 

Syringe  and  needle  are  sterilized  before  using.  The  solutions  are  so 
made  that  gr.  1/5  of  mercuric  sucdnimid  is  dissolved  in  four  minims  of 
hot,  sterile  distilled  water. . 

The  site  of  injection  is  the  buttock,  using  alternating  sides  for  suc- 
ceeding injections.  The  skin  is  sterilized  with  tincture  of  iodin.  The 
method  of  inserting  the  needle  is  as  follows:  The  needle  butt  is  held  be- 
tween the  thumb  and  third  finger  with  the  index  finger  over  the  butt,  the 
shaft  of  the  needle  to  be  perpendicular  to  the  skin  surface,  the  point 
about  three  inches  distant  from  it.  With  a  quick,  forceful,  downward 
thrust,  the  needle  is  driven  deeply  into  the  substance  of  the  gluteal  mus- 
cles, from  point  to  butt.  Then  into  the  syringe  as  many  minims  of  the 
sterile  mercuric  solution  as  represent  the  desired  dose,  are  drawn;  if  it 
is  to  be  gr.  5/5,  minims  xx  will  be  required.  Then  the  syringe  tip  is  in- 
serted into  the  socket  of  the  needle,  and  the  injection  is  made  slowly. 
The  needle  is  withdrawn,  and  tincture  of  iodin  is  applied  to  the  point 
of  injection.    The  injections  are  to  be  repeated  every  seventh  day. 

In  conclusion  let  me  say  that  I  believe  the  profession  and  humanity 
are  greatly  indebted  to  Dr.  Barton  Lisle  Wright,  surgeon  U.  S.  Navy,  for 
this  wonderful  discovery.  It  seems  that  at  last  we  have  conquered  a 
disease  that  has  puzzled  and  endangered  the  human  race  from  time  im- 


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102  THB  DENTAL  DIGBST 

memorial.  Perhaps  the  most  satisfactory  part  of  this  discovery  is  that 
the  discoverer  is  an  American,  an  officer  in  that  most  efficient  organiza- 
tion, the  United  States  Navy. 


[The  Dental  OtUlook,  February,  1916] 

Original  Communications 

♦The  Relationship  of  the  Pediatrist  and  the  Dentist.    By  G.  R.  Pisek,  M.D. 
Impression  Method  for  Edentulous  Mouths,  with  Modeling  Compound.     By  Dr.  J.  P.  Ruyl. 
A  Suggestion.    By  H.  Schwamm,  D.D.S.,  LL.B. 
The  Purpose  of  Our  Dental  Societies  and  Their  Official  Organ,  "The  Dental  Outlook." 

By  S.  Herder,  D.D.S. 
Quality  and  Quantity.    By  Dr.  M.  Schneer. 
Mounting  of  Crown  and  Bridgework.    By  Goslee. 
Hails  Awakened  Health  Conscience. 
Monthly  Report  of  Legislation  Committee  of  The  Allied  Dental  Council. 

Editorial 
Proposed  New  Law  Regulating  Administration  of  General  Anesthetics  by  Dentists. 
THE  RELATION  OF  PEDIATRIST  AND  DENTIST 
By  G.  R.  Pisek,  M.D.,  New  York 

It  is  a  sad  fact  shown  by  a  committee  of  the  A.  M.  A.  that  48.8  per 
cent,  of  the  children  of  rural  communities  and  33.50  per  cent,  of  city 
children  were  found  to  have  defective  teeth,  and  we  are  only  now  just 
beginning  to  scratch  the  surface  very  feebly  with  a  few  dental  clinics  to 
correct  these  defects.  The  physicians  need  the  whole-souled  cooperation 
of  dentists  in  the  care  of  the  mouth  of  the  child.  It  must  be  admitted 
that  the  dentists  have  not  given  of  their  best  to  the  child.  The  rank  and 
file  of  the  dental  profession  as  a  whole,  have  not  supported  in  practice  the 
contention  that  the  primary  teeth  should  be  carefully  preserved.  Ex- 
traction is  too  often  resorted  to  where  a  filling  could  have  been  placed  if 
the  necessary  time  and  patience  were  used. 

There  is  a  need  for  dentists  who  are  willing  to  devote  attention  to  the 
mouths  of  children,  and  who  would  take  charge  in  the  same  manner  as 
the  physician  would  in  cases  of  specific  illness.  There  should  be  more 
personal  cooperation  between  the  physician  and  the  dentist,  particularly 
in  the  cases  to  be  mentioned  later  in  which  other  therapeutic  aids  besides 
the  orthodontic  are  necessary  to  affect  the  well  being  of  the  child. 

Physicians  in  the  last  few  years  have  had  their  attention  forcibly 
called  to  the  foci  of  infection,  which  may  occur  in  or  about  the  mouth. 
They  are  aware  of  the  fact  that  a  number  of  diseases  heretofore  of  ob- 
scure etiology  may  be  attributed  to  pus  pockets  at  the  roots  of  teeth. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    193 

In  fact  the  pendulum  is  perhaps  swinging  too  far  in  this  one  direction, 
but  nevertheless  attention  is  well  centred  upon  the  hygiene  of  the  mouth 
and  the  dental  profession  should  be  prepared  and  ready  to  cooperate 
with  physicians,  seeking  advice  for  their  patients.  The  effort  must  centre 
Itself  in  the  prevention  of  dental  caries  and  Rigg's  disease.  Early  and 
serious  dietetic  errors  during  infancy  and  the  early  years  of  life  have  a 
marked  effect  on  the  production  of  irregular  dentition,  deformed  and 
carious  teeth.  The  dentist  should  be  able  to  recognize  the  effects  of 
improper  diet  in  the  mouth,  and  be  capable  of  recognizing  that  the  con- 
dition is  due  to  dietetic  error. 

The  dentist  need  not  and  should  not  attempt  to  regulate  the  feedings 
of  children,  but  he  should  have  a  clear  conception  of  the  scientific  founda- 
tions of  the  art,  so  that  he  may  be  able  to  detect  the  evidences  of  improper 
feeding  and  direct  his  patient  into  the  right  channels  for  correction. 

The  maternal  nutrition  of  the  infant  commences  at  conception.  The 
developing  ovum  at  first  absorbs  nutriment  from  the  fluids  by  which  it  is 
surrounded,  but  as  the  organism  develops  it  attaches  itself  to  the  wall  of 
the  uterus  and  through  it  obtains  food.  As  organization  becomes  more 
complex  the  placenta  is  formed,  and  gradually  the  circulation  of  the  blood 
is  established.  When  birth  occurs  a  sudden  change  in  the  method  of 
obtaining  food  takes  place.  The  mother  now  supplies  it  from  the  breasts 
instead  of  through  the  placenta.  At  first  she  secretes  colostrum,  but 
this  is  soon  displaced  by  milk  which  she  supplies  until  teeth  are  cut  and  the 
infant  is  ready  for  solid  food.  During  the  time  the  infant  is  at  the  breast 
its  digestive  organs  are  slowly  assimiing  the  form  of  those  of  the  adult 
and  are  gradually  developing  their  functions,  as  is  shown  by  the  ability 
to  take  solid  food  a  littie  at  a  time.  During  the  time  the  digestive  organs 
are  developing  Nature  sees  that  the  infant  has  food  that  is  specially 
suited  to  it. 

The  reason  why  foods  that  do  not  contain  fresh  milk  are  not  suc- 
cessful in  the  long  run  for  feeding  infants,  is  that  they  do  not  have  the 
property  of  adapting  themselves  to  the  changing  stomach  and  keeping  it 
prof)erly  at  work.  Unmodified  cow's  milk  disagrees  with  most  young 
infants  because  of  the  character  of  the  solid  formed  from  it  when  it  comes 
in  contact  with  the  pepsin  of  the  stomach. 

Most  important  from  the  dental  standpoint  is  the  fact  that,  the  true 
growth  of  the  body — the  formation  of  muscle  and  bone — is  absolutely 
dependent  on  the  proteid  obtained  from  the  food,  which  is  represented 
by  lean  meat,  eggs,  curd  of  milk,  gluten  of  cereal,  etc.  If  this  element 
of  the  food  is  deficient,  a  weakened  constitution  will  result,  although  the 
infant  may  gain  in  weight  rapidly  if  there  is  sufficient  sugar  present.  If 
there  is  enough  proteid,  but  insufficient  sugar  and  fat  in  the  food,  stunting 


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194  THE  DENTAL  DIGEST 

will  follow  because  the  proteid  cannot'be  stored  up  as  new  tissue,  but  must 
be  used  for  the  current  needs  of  the  body,  which  would  normally  be  met 
by  the  sugar  and  fat. 

Again  the  dentist  should  be  able  to  differentiate  the  syphilitic  teeth 
of  the  second  dentition  from  the  irregular,  deformed  teeth  occurring  in 
the  mouths  of  children  with  mental  deficiencies. 

From  the  pediatrician's  standpoint  the  dentist  should  recollect  that 
children  who  are  artificially  fed,  have  generally  weaker  teeth. 

[Dominion  Dental  Journal,  January,  1916] 
Contents 

Original  Communications 

•Systemic  Disorders  as  the  Result  of  Oral  Sepsis.    By  Andrew  J.  McDonagh,  D.D.S.,  L.D.S., 

Toronto,  Ont. 
Abscess  of  the  Antrum.    By  E.  C.  McDonald,  D.D.S.,  Toronto,  Ont. 
A  Better  Knowledge  of  Dental  Pathology  Desirable.     By  F.  H.  Krueger,  D.D.S.,  L.D.  S., 

Toronto,  Ont. 
An  Antrum  Case  of  Long  Standing.    By  A.  E.  Webster,  M.D.,  D.D.S. 
Amalgam  Technique. 

A  Trip  in  War  Times.    By  A.  W.  Thornton,  D.D.S.,  L.D.S.,  Montreal,  Que. 
Duty  and  Responsibility  of  Members  of  Faculty  Council  of  the  Royal  College  of  Dental 

Surgeons  of  Ontario.    By  A.  E.  Webster,  D.D.S.,  L.D.S.,  M.D.,  Dean. 
The  Recently  Embarked  Overseas  Draft  of  the  Canadian  Army  Dental  Corps.  By  James  M. 

Magec,  D.D.S.,  L.D.S.,  St.  John,  N.  B. 

Dental  Societies 

Ontario  Oral  Hygiene  Conference. 
Toronto  Dental  Society. 
Medical  Inspection  Department,  Calgary. 
"Canada."    By  Mark  G.  McElhinney. 

Editorial 

Dental  Students  Who  Enlist. 

Military  Convalescent  Hospitals  in  Canada. 

The  Dentist  is  More  than  a  Mechanic. 

Correspondence 
Letter  from  Jos.  Nolin. 

Obituary 
Clarence  R.  Minns,  D.D.S.,  L.D.S. 

SYSTEMIC  DISORDERS  AS  THE  RESULT  OF  ORAL  SEPSIS 
By  Andrew  J.  McDonagh,  D.D.S.,  L.D.S.,  Toronto,  Ont. 

If  a  tooth  has  an  abscess  encompassing  the  end  of  the  root,  which  is 
apparently  encysted,  at  the  end  of  the  roots  of  the  teeth  immediately 


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AN  EPITOMB  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE      19$ 

adjoining  that  tooth,  although  the  teeth  are  alive  and  perfectly  healthy, 
will  be  found  the  same  micro-organisms  as  are  contained  in  the  abscess, 
showing  that  the  micro-organisms  have  penetrated  the  walls  of  the  abscess 
and  invaded  the  contiguous  tissues,  showing  also  a  probable  avenue  into 
the  circulation.  Now,  the  harm  which  may  be  done  if  these  organisms 
enter  the  circulation  either  by  this  avenue  or  any  other  avenue  which  we 
will  speak  of  later  on,  may  be  done  either  by  destroying  the  blood  itself; 
in  other  words,  by  haemolyzing  it,  or  the  harm  may  be  done  by  the  blood 
stream  carrying  these  organisms  to  distant  parts  of  the  body,  where  they 
will  find  congenial  habitation,  notably  in  the  heart,  the  joints  and  cellular 
tissue.  There  is  a  great  difference  in  opinion  between  pathologists  as  to 
the  proportion  of  alveolar  abscesses  which  contain  haemolytic  organisms, 
Hartzell  claiming  that  in  his  investigations  only  one  in  two  hundred 
abscesses  contained  haemolytic  organisms.  This  great  difference  of 
opinion  possibly  is  accounted  for  by  the  different  manner  in  which  investi- 
gators culture  their  organisms,  but  in  my  experience  there  is  this  to  say, 
if  the  organism  in  a  blind  abscess  is  a  haemolytic  organism,  the  abscess 
is  much  smaller  and  much  more  difficult  to  find  by  X-ray.  This  probably 
is  due  to  the  difference  in  the  pyogenic  qualities  of  the  two  organisms. 

In  making  and  reading  radiographs  our  difficulties  are  enhanced,  be- 
cause an  abscess  caused  by  an  infected  pulp  canal  does  not  always  form 
at  the  end  of  a  root,  does  not  always  form  in  a  position  easily  detected  in 
a  skiagram;  in  other  words,  the  root  very  often  hides  the  abscess,  and 
your  only  guide  is  the  condition  of  the  lineadura  and  your  knowledge  of 
the  appearance  a  healthy  root  ought  to  have.  This  is  exceptionally  true 
of  the  molars  on  which  the  abscess  often  forms  at  the  bifurcation  of  the 
roots,  and  is  an  exceedingly  virulent  abscess.  A  man  to  make  a  diagnosis 
should  never  absolutely  rely  upon  his  skiagram;  he  must  use  either 
thermal  changes  or  high  pressure  electric  current,  or  both,  to  help  in  his 
work.  Just  one  word  more  about  abscesses  on  the  teeth.  It  is  not 
unusual  for  a  man  examining  a  patient's  mouth  to  base  his  diagnosis  on 
that  which  is  most  apparent,  namely,  sinuses  and  visable  concretions. 
Nothing  in  this  field  is  more  deceiving  or  more  disappointing.  Multiple 
abscesses  discharging  through  sinuses  into  the  mouth  are  not  as  bad  as 
one  abscess  (so-called  blind  abscess)  which  has  no  sinus,  the  whole  con- 
tents of  which  must  be  absorbed  by  the  surrounding  tissue,  and  we  must 
not  forget  that  in  this  case  the  surrounding  tissue  is  composed  of  highly 
vascular  cancellous  bone. 

These  blind  abscesses  very  often,  in  fact,  in  the  majority  of  cases,  do 
not  cause  any  great  discomfort  to  the  patient;  the  teeth  are  not  sore,  the 
gums  are  not  swollen,  and  if  you  make  a  single  X-ray  plate  of  all  the 
teeth  ancl  the  jaws  pf  the  mouth  you  may  not  discover  the  abscess. 


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196  THE  DENTAL  DIGEST 

Another  fact  which  is  sometimes  overlooked  is  that  organisms  contained 
at  the  end  of  the  different  teeth  roots  in  the  mouth  may  be,  and  very 
often  are,  as  different  as  possible  in  different  localities  in  the  same  mouth; 
that  is,  you  may  have  at  the  end  of  one  of  the  centrals  a  non-haemolytic 
streptococcus  veridans,  and  at  the  end  of  a  bicuspid  root  a  haemolytic 
streptococcus,  and  so  on,  consequently  every  root  and  every  abscess  sac 
must  be  made  sterile. 

[Journal  American  Medical  Association^  January  15,  1916] 

THE  ACTION  OF  COCAIN 

Aside  from  its  action  as  a  local  anesthetic,  and  its  stimulating  and 
then  depressing  action  on  various  parts  of  the  central  nervous  system, 
cocain  has  three  effects  which  have  especially  aroused  the  interest  of 
clinicians  and  pharmacologists.  These  are  the  dilation  of  the  pupil,  the 
local  constriction  of  certain  blood  vessels,  and  the  acceleration  of  the 
heart  sometimes  seen  in  cases  of  poisoning  by  this  drug.  The  first  two 
are  of  very  practical  importance.  Cocain  is  in  constant  use  as  a  mydri- 
atic, and  extensive  use  is  also  made  of  its  constricting  action  on  the  dilated 
vessels  of  the  conjunctiva,  etc.  Its  advantages  as  a  local  anesthetic 
over  its  more  recent  rivals  are  in  part  attributed  to  its  local  vasoconstrict- 
ing  effect.  Since  the  introduction  of  mixtures  of  novocain,  etc.,  and 
epinephrin,  however,  this  inherent  advantage  of  cocain  has  become  of  less 
importance;  the  epinephrin  adds  to  these  mixtures  an  important  action 
not  p)ossessed  by  the  anesthetics  alone. 

There  has  been  much  discussion  as  to  just  how  cocain  brings  about 
dilatation  of  the  pupil  and  the  local  constriction  of  blood  vessels.  For 
many  years  the  view  has  been  current  that  it  stimulates  the. endings  of 
the  sympathetic  nerves  in  the  iris.  This  view  was  based  chiefly  on  the 
observation  that  after  these  nerves  were  cut  and  allowed  to  degenerate, 
cocain  had  a  much  less  dilating  effect  on  the  pupil,  or  none  at  all.  This 
explanation  has  never  been  entirely  satisfactory;  all  writers  have  had 
to  admit  that  it  does  not  explain  all  the  observed  facts.  It  has  been 
accepted,  however,  as  the  more  plausible  explanation  for  the  major  part 
of  the  facts,  and  recent  writers  seem  to  have  been  little  disturbed  by  the 
facts  which  it  does  not  explain.  The  other  actions,  the  vasoconstricting 
and  the  acceleration  of  the  heart,  have  not  been  the  subject  of  much  inves- 
tigation, but  there  has  been  a  tendency  to  explain  them  also  as  a  result 
of  an  increased  activity  of  sympathetic  nerve  endings.*  In  fact,  cocain 
is  now  frequently  grouped  with  epinephrin  as  a  drug  having  a  selective 

♦Meyer,  H.  H.,  and  Gottlieb,  R,:  Pharmacology,  Clinical  and  Experimental,  p.  158. 

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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    197 

Stimulating  action  on  the  endings  of  the  true  sympathetic  nervous 
system.* 

It  appears,  however,  from  recent  work  carried  out  by  Kuroda,t  in 
the  pharmacologic  laboratory  of  Professor  Cushny  of  London,  that  such 
a  generalization  was  premature  and  not  sufficiently  well  supported  by 
experimental  facts.  Kuroda  showed  that  the  action  of  cocain  differs 
widely  from  that  of  epinephrin  or  sympathetic  nerve  stimulation:  thus 
it  dilates  the  vessels  when  perfused  through  an  organ,  whereas  epinephrin 
or  sympathetic  nerve  stimulation  causes  an  intense  constriction;  it  de- 
presses the  action  of  the  isolated  heart,  whereas  sympathetic  nerve  stimu- 
lation or  epinephrin  powerfully  stimulates  this  organ;  small  doses  of 
cocain  augment  the  activity  of  the  intestine,  and  large  doses  depress  it, 
whereas  with  epinephrin  or  sympathetic  nerve  stimulation  there  is  only 
a  depression.  There  is  a  similar  lack  of  correspondence  between  the 
action  of  cocain  and  of  epinephrin  or  sympathetic  nerve  stimulation  in 
the  case  of  the  stomach,  uterus,  bladder,  and  salivary  glands.  In  nearly 
all  cases,  cocain  was  found  first  to  increase  the  activity  of  unstriated 
muscle  and  then  to  depress  it,  whatever  may  be  the  nature  of  the  sym- 
pathetic control;  in  some  instances  the  phase  of  increased  activity  was 
not  observed.  In  view  of  these  results  and  the  fact  that  the  explanation 
that  the  dilatation  of  the  pupil  results  from  a  stimulation  of  the  endings 
of  the  sympathetic  nerve  has  always  been  regarded  as  inadequate,  Kuroda 
argues  that  the  dilatation  of  the  pupil  under  cocain  also  arises  from  a 
direct  depressing  action  of  the  drug  on  the  muscle  of  the  iris.  The 
vasoconstricting  action  of  cocain  which  is  seen  when  the  drug  is  applied 
directly  to  a  congested  mucous  membrane  is  not  so  readily  explained,  but 
it  is  evidently  of  a  different  character  from  that  caused  by  epinephrin  or 
sympathetic  nerve  stimulation;  the  effects  of  the  latter  agencies  are 
very  evident  in  isolated  organs,  and  are  always  readily  obtained,  whereas 
cocain  causes  a  dilation  of  blood  vessels  under  similar  conditions.  The 
acceleration  of  the  heart  in  the  intact  animal  is  evidently  not  analogous 
to  the  action  of  epinephrin;  it  may  be  due  to  an  action  on  the  central 
nervous  system. 

At  first  thought  it  may  seem  rather  discouraging  that  there  should 
still  be  so  much  doubt  as  to  the  true  action  of  such  a  widely  used  mydriatic 
as  cocain;  but  it  should  be  remembered  that  such  problems  are  very 
complex  and  that  the  number  of  men  seriously  working  to  elucidate 
them  are  few. 

•See,  for  example,  Wolfsohn,  J.  M. :  The  Normal  and  Pathologic  Physiology  of  the  Visceral 
Nervous  System,  The  Journal  A.  M.  A.,  May  i6,  1914,  p.  1535. 

fKuioda:  Jour.  Phannacol.  and  Exper.  Therap.,  191^,  vii,  423. 

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198  THB  DBNTAL  DIGEST 

[Journal  American  Medical  Association^  January  22,  1916] 

THE  TECHNIC  OF  ORAL  HYGIENE 

''Dentistry,  which  is  a  highly  specialized  branch  of  surgery,  should 
use  the  two  factors,  asepsis  and  anesthesia,  which  have  made  possible 
the  wonders  of  modem  surgery,  with  skill  and  precision  equal  to  that  of 
surgeons."  This  is  the  theme  emphasized  by  Hasseltine*  of  the  United 
States  Public  Health  Service  as  the  result  of  an  investigation,  imdertaken 
at  the  request  of  prominent  dentists,  to  work  out  a  detailed  method  for 
sterilizing  dental  instruments  and  appliances,  keeping  in  mind  the  im- 
portant factors  simplicity,  efficiency,  and  duration  of  the  process  of 
sterilization.  Any  one  trained  in  modem  methods  of  asepsis  who  has 
watched  the  technic  at  present  employed  in  the  usual  routine  of  dental 
treatment  will  have  observed  the  errors  which  are  almost  inevitably 
allowed  to  creep  in,  and  the  attendant  possibility  of  bacterial  contamina- 
tion and  transmission  of  infection  from  one  patient  to  another.  The 
entire  question  of  oral  sepsis  and  mouth  hygiene  has  been  put  into  even 
greater  prominence  of  late  by  the  attention  centred  on  the  unexplored 
possibilities  of  infection  through  the  mouth.  The  situation  has  been 
analyzed  by  the  statement  that  "from  the  standpoint  of  efficiency  the 
modern  mouth  is  out  of  adjustment  with  modem  conditions — or,  perhaps 
we  should  say,  modem  conditions  are  out  of  adjustment  with  it.  Not- 
withstanding the  numerous  bacteria  that  flourish  within  its  portals, 
mouth  secretions  and  the  mucous  membranes  do  not  seem  to  have  the 
protecting  power  which  is  often  manifest  in  other  regions  of  the  body 
and  which  protects  an  animal  in  a  state  of  nature,  "t 

The  danger  from  focal  infections  in  which  streptococci  are  present  in 
the  tonsils  and  about  the  teeth  is  becoming  more  widely  appreciated  now 
that  the  possibilities  for  harm  in  such  chronic  foci  are  being  recognized 
on  the  basis  of  careful  scientific  investigation.  In  referring  to  what  may 
be  called  "internal  streptococcal  metastasis"  attended  by  the  localization 
of  mouth  streptococci  in  the  interior  of  the  body,  it  was  pointed  out 
recetitlyj  that  the  efforts  now  made  to  detect  and  then  to  obliterate  all 
forms  of  focal  infection  in  the  mouth  and  throat  as  well  as  elsewhere  in 
the  body,  for  preventive  as  well  as  curative  purposes,  besides  being  in 
accord  with  sound  reasoning  from  general  principles,  receive  the  support 
also  of  strong  experimental  evidence. 

As  illustrations  of  the  possibility  of  transmission  of  mouth  organisms 

♦Hasseltine,  H.E.:  The  Sterilization  of  Dentallnstruments,  Bull.  loi,  Hyg.  Lab.,  U.  S. 
P.  H.  S.,  1915,  p.  53. 

tHow  to  Live,  New  York,  Funk  and  Wagnalls,  1915,  p.  78. 

JThe  Localization  of  Strept99p9fij  editori^,  Jhe  /oj4fftfU  A.  M.  A.,  Nqy,  X^,  i§i$,  p.  173a, 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     199 

from  one  person  to  another  through  the  medium  of  dental  practices, 
Hasseltine*  mentions  the  placing  of  sterilized  instruments  on  a  swinging 
tray  or  glass  plate  which  has  not  been  sterilized,  the  cleaning  of  burs  on 
a  scratch  wheel  which  has  not  been  sterilized  since  the  burs  used  on  the 
previous  patient  have  been  cleaned  on  it,  and  the  frequent  handling  of 
the  cable  of  the  dental  engine,  which  receives  contamination  from  one 
patient  through  the  operator's  hands  and  in  turn  returns  a  portion  of  this 
contamination  to  the  operator's  hands  when  used  on  subsequent  patients. 
These  familiar  errors,  as  Hasseltine  expresses  it,  emphasize  the  necessity 
of  having  everything  which  comes  in  contact  with  the  instruments  or 
hands  of  the  operator  free  from  organisms  obtained  from  previous  patients 
in  order  to  prevent  transmission  of  infection  from  one  patient  to  another. 
Every  dentist  or  oral  surgeon  will  find  useful  hints  and  practical  sug- 
gestions in  the  outcome  of  the  investigation  of  the  Hygienic  Laboratory.! 
The  reconunendations  for  the  sterilization  of  dental  instruments  point 
out  that  moist  heat  is  our  best  disinfecting  agent  for  the  sterilization  of 
all  metal  instruments.  For  the  destruction  of  nonspore-bearing  bacteria, 
moist  heat  at  80  C.  (176  F.)  is  nearly  as  efficient  as  boiling,  and  for 
practical  purposes  can  be  used  in  place  of  boiling.  Instruments  con- 
structed of  metal,  whose  complicated  mechanism  has  heretofore  caused 
them  to  be  considered  as  nonsterilizable,  can  be  sterilized  by  moist  heat, 
provided  the  water  is  removed  from  them  by  immersing  in  alcohol  sub- 
sequent to  sterilization.  Instruments  whose  construction  does  not 
permit  of  boiling  can  be  sterilized  by  chemical  disinfectants.  In  the 
latter  procedure,  immersion  in  5  per  cent,  solution  of  phenol  (carbolic 
add)  for  at  least  sixty  minutes  is  recommended;  and  in  those  cases  in 
which  the  mechanical  construction  makes  it  difficult  to  remove  excess  of 
water,  instruments  can  be  placed  in  95  per  cent,  alcohol  for  a  few  minutes 
to  remove  water,  and  then  allowed  to  dry. 

The  courses  of  instruction  in  dental  surgery  of  to-day  are  giving  atten- 
tion to  the  bacteriology  of  the  subject  and  its  relation  to  mouth  hygiene 
as  well  as  to  general  health.  It  is,  however,  a  distinct  advantage  to  have 
the  practical  results  of  actual  tests  of  sterilizing  agents '  available  for 
professional  men  who  have  Uttle  opportunity  for  personal  experience 
in  the  laboratory  work  involved.  Hasseltine  well  remarks  that  the 
student  usually  forms  the  opinion  that  any  sterilizing  agent  is  effective, 
and  does  not  learn  to  check  his  sterilization  by  bacteriologic  tests.  For 
this  reason  he  believes  that  in  dental  schools  and  clinics  there  is  need  for 
the  giving  of  more  practical  instruction  in  the  methods  of  sterilization, 
and  the  subsequent  testing  of  these  by  bacteriologic  methods. 

*0p.  cU.  fApplications  for  the  publication  referred  to  should  be  addressed  to  the  Sur- 
geon General,  U.  S.  Public  Health  Service,  Washington,  D.C. 


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200  THB  DBNTAL  DIGEST 

[Journal  American  Medical  Associaiiony  February  5,  1916] 
(British  Medical  Journal,  January  i,  1916) 

TREATMENT  OF  INFECTED  GUNSHOT  WOUNDS 

Army  surgeons,  according  to  Gray,  have  been  compelled,  since  this 
war  began,  to  acknowledge  the  ineflSdency  of  antiseptics  when  used  as  a 
preventive  or  for  disinfecting  agents  in  badly  infected,  lacerated  woimds. 
Until  applications  were  employed  which  stimulated  a  concentration  of 
the  general  defensive  forces  of  the  body  in  and  around  the  wound,  no 
real  advance  in  treatment  was  made.  It  mattered  not  what  kind  or  what 
strength  of  antiseptic,  pure  and  simple,  was  used,  the  infection  ran  a 
fairly  definite  course  of  fairly  definite  duration,  which  varied  merely 
according  to  the  patient's  power  of  resistance.  While  the  importance 
of  free  drainage  was  speedily  acknowledged,  quite  a  long  time  passed 
before  there  was  any  satisfactory  recognition  of  the  fact  that  the  resisting 
agencies  of  the  patient's  own  body  are  far  more  effective  in  dealing  with 
a  local  infection  than  any  purely  antiseptic  solution,  powder,  or  paste 
introduced  into  it  from  without.  It  has  been  proved  that  the  use  of  salt 
solutions  applied  in  various  ways,  fulfils  all  the  striking  claims  made  for 
it  by  Wright.  Hypertonic  saline  dressing,  especially  in  the  form  now 
known  as  the  ''tablet  and  gauze  pack,"  fulfils  all  desiderata  better  than 
any  other  yet  applied. 

After  the  wound  has  been  cleaned  by  operation,  all  the  recesses  of  the 
woimd  should  be  sought  out  by  the  finger,  and  filled,  fairly  firmly, 
with  gauze  wrung  out  of  5  to  10  per  cent,  salt  solution,  in  the  folds 
of  which  are  placed  numerous  tablets  of  salt.  Blood  clot  which  may  form 
during  the  packing  should  be  wiped  away.  The  gauze  should  be  packed 
in  concertina-wise,  a  tablet  being  placed  between  every  third  or  fourth 
fold.  A  fairly  large,  fenestrated  rubber  tube  is  placed  so  as  to  reach 
to  the  deepest  part  of  the  main  cavity,  which  is  then  filled  with  gauze 
and  tablets.  The  dressing  is  made  flush  with  the  skin  and  the  tube  pro- 
jects slightly  from  its  midst.  The  surrounding  skin  is  painted  with 
solution  of  iodin  or  other  antiseptic  application.  Two  or  three  layers  of 
gauze  are  then  used  to  cover  the  woimd  and  surroimding  skin.  A  suitable 
amount  of  absorbent  cottonwool  is  applied  and  a  bandage  wound  on 
smoothly  and  firmly. 

[The  Internalional  Journal  of  Orthodontia,  January,  1916] 
Contents 

Original  Articles 

Suggestions  in  X-ray  Technic  for  the  Orthodontist.    By  Dr.  James  David  McCoy,  Los 
Angeles,  Calif. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    201 

An  Effective  Method  for  the  Mesial  or  Distal  Movement  of  Individual  Teeth  in  the  Arch. 

By  Harry  E.  Kelsey,  D.D.S.,  Baltimore,  Md. 
Treatment  by  the  Orthodontist  Supplementing  that  by  the  Rhinologist.    By  A.  H.  Ketcham, 

D.D.S.,  Denver,  Colo. 
The  Technic  of  Accurate  Impression  Taking.    By  Samuel  J.  Lewis,  D.D.S.,  Kalamazoo, 

Mich. 
The  History  of  Orthodontia  (Continued).    By  Bemhard  W.  Weinberger,  D.D.S.,  New  York 

City. 

Editorials 

Cooperation  between  the  Dentist  and  the  Orthodontist. 
Bands  vs.  Ligature. 

The  Teaching  of  Orthodontia  in  Dental  Colleges. 
The  Esthetic  Side  of  Orthodontia. 

[Pacific  Dental  Gazette,  January,  191 6] 
Original  Articles 

Efficiency  in  Tooth  Brushing.    By  Engstrom. 

Dental  Pediatrics.    By  Gurley. 

The  First  Plaster  Impression,  and  First  Suction  Plate.    By  Haskell. 

pAlitorial 
Are  Root  Canals  Being  Overtreated? 

Selections 

Chemical  Studies  of  Relations  of  Micro-Organisms  to  Dental  Caries.    Gies  and  Collaborators. 
A  Pressing  Need  in  Dentistry.    By  Johnson. 

Practical  Suggestions 
Conducted  by  John  C.  Hopkins,  D.D.S. 

Dental  Excerpts 

Concerning  Inlays.    By  Hinman. 

The  Financial  Ally  of  the  Pyorrhea  Specialist.    By  Endelman. 

Mercury  Chlorid  in  Surgery. 

[The  Denial  Summary,  February,  19 16] 

Regular  Contributions 

Suggestion  and  Auto-suggestion  in  its  Relation  to  Dentistry.    By  W.  F.  Stone. 

Split  Matrix  and  Amalgam  Filling.    By  Drs.  Barclay  and  McCready. 

How  to  Sterilize  the  Tooth  Brush.    By  Hugh  W.  MacMillan. 

Dental  Pathology  and  its  Relation  to  Systemic  Disease.    By  T.  A.  Leonard. 

Correlating  Conditions  Common  to  Nose,  Throat,  and  Oral  Surgery.    By  E.  B.  Cayce. 

Porcelain  Inlays.    By  F.  B.  Roberts. 

Impression  Taking,  Using  Modeling  Compound.    By  J.  V.  Howard. 

What  All  Dentists  Should  Know  About  Orthodontia.    By  W.  E.  Lundy. 


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202  THE  DENTAL  DIGEST 

Dates  of  Some  Old  Dental  Patents.    By  H.  L.  Ambler. 

President's  Address.    By  David  P.  Houston. 

Some  Thoughts  on  Education.    By  Henr>'  W.  Morgan. 

Pyorrhea.     By  A.  ClifTord  Braly. 

Some  Dental  Hints.     By  J.  B.  Kelly. 

The  Sterilization  of  Dental  Instruments.    By  H.  E.  Hasseltine. 

A  Review  of  Some  Drugs  Old  and  New.    By  S.  F.  M.  Hirsch. 

Dentistry,  in  its  Progress  Through  the  Century,  to  Stomatology  as  a  Science.    By  James 

Truman. 
Plastic  Surgery  of  the  Face.    By  W.  A.  Bryan. 
Local  Anesthesia  in  Dentistry.    By  B.  H.  Johnson. 


[Dental  Items  of  Interest^  February,  1916] 
Exclusive  Conlributions 

Origin  and  Metastatic  Importance  of  Chronic  Oral  Infections.    By  E.  J.  Eisen,  D.D.S.; 

R.  H.  Ivy,  M.D.,  D.D.S. 
A  Short  Cut  in  the  Indirect  Method  of  Making  Cast  (>old  Inlays.     By  Louis  Herbst,  D.D.S. 

Radiodontia 

"Bad  Canal  Work";  What  ShaU  We  Do  About  it?    By  Howard  R.  Raper,  D.D.S. 

Society  Papers 

An  Acidimetric  Study  of  the  Saliva  and  Its  Relation  to  Diet  and  Caries.    By  John  Albert 

Marshall. 
Medical  Superstitions.    By  Garrett  Newkirk. 
The  Professional  Side  of  Dentistry.    By  Frank  P.  Duflfy,  D.D.S. 

[The  Texas  Dental  Journal^  January,  1916] 
Original  Communications 

The  Evolution  of  Prosthetic  Dentistry. 
The  Bigness  of  Little  Things. 
The  Dentist:  Who  Is  He? 

With  Our  Contemporaries 

Modern  Attachments  for  Bridge  Work. 

Malarial  Mosquitoes  as  the  Food  of  Bats. 

Should  All  Teeth  Be  Saved? 

Operative  Procedures  in  Relation  to  Dental  Caries  and  Diseases  of  the  Investing  Tissues. 

Relationship  Between  Medicine  and  I)entistr\'. 

Porcelain-Faced  Molar  Cro\N-n. 

Gold  Inlays  with  Synthetic  Cement  Inserts. 

Hemorrhage,  Post-Operative — The  Use  of  Coagulose  as  a  Prophylactic. 


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SOCIETY  NOTES  203 

SOCIETY  NOTES 

Alabama. 

The  next  meeting  of  the  Alabama  Dental  Association  will  be  held  at  Mobile,  Ala.,  April 
II,  1916. — J.  A.  Blue,  Birmingham,  Ala.,  Secretary, 

Arkansas. 

The  next  meeting  of  the  Arkansas  State  Dental  Association  will  be  held  at  Little  Rock, 
Ark.,  March  28-30,  1916. — Wm.  B.  Dorman,  Nashville,  Secretary, 

Florida. 

The  next  meeting  of  the  Florida  State  Dental  Society  will  take  place  at  Orlando,  Fla., 
June  21,  1916. — M.  C.  Izlar,  Ocala,  Fla.,  Secretary. 

Ilunois. 

The  Illinois  State  Dental  Society  will  hold  its  next  meeting  at  Springfield,  111.,  May 
9-12,  1916. — Henry  L.  Whipple,  Quincy,  TIL,  Secretary. 

Iowa. 

The  next  meeting  of  the  Iowa  State  Dental  Society  will  take  place  at  Des  Moines,  Iowa, 
May  2-4. — H.  A.  Elmquist,  Des  Moines,  Iowa,  Chairman  of  Exhibit. 

Maryland. 

The  next  meeting  of  the  Maryland  State  Dental  Association  will  be  held  in  Baltimore, 
Md.,  March  25,  1916. — F.  F.  Drew,  Baltimore,  Md.,  Secretary. 

Massachusetts. 

The  next  meeting  of  the  Massachusetts  Dental  Society  will  be  held  in  Boston,  Mass. 
May  3-5,  1916. — A.  H.  St.  C.  Chase,  Boston,  Mass.,  Secretary. 

Michigan. 

The  Michigan  State  Board  of  Dental  Examiners  will  meet  in  the  Dental  College  at  Ann 
Arbor,  June  19, 1916,  at  eight  o'clock  a.m.;  for  application  blanks  apply  to  E.  O.  Gillespie, 
Stephenson,  Mich.,  Secretary-Treasurer. 

Mississippi. 

The  next  meeting  of  the  Mississippi  Dental  Association  will  be  held  at  Jackson*  Miss., 
May  1-3,  1916.    M.  B.  Varnado,  Osyka,  Miss.,  Secretary. 

Missouri,  Kansas,  Oklahoma. 

The  Tri-State  Post  Graduate  Dental  meeting  will  be  held  at  Kansas  City,  Mo.,  March 
20-26,  1916. — C.  L.  Lawrence,  Enid,  Okla.,  Secretary. 

Nebraska. 

The  Nebraska  State  Dental  Society  will  hold  its  next  meeting  in  Lincoln,  Nebr.,  May 
16-18,  1916. — H.  E.  King,  Omaha,  Nebr.,  Secretary. 

New  York. 

The  Dental  Society  of  the  State  of  New  York  wall  hold  its  next  meeting  at  the  Hotel 
Ten  Eyck,  Albany,  N.  Y.,  May  11-13,  1916. — A.  P.  Burkhart,  52  Genesee  St.,  Albany, 
N.  Y.,  Secretary. 

New  York. 

The  next  meeting  of  the  Sixth  District  Dental  Society  of  New  York  will  be  held  at  Hotel 
Bennett,  Binghamton,  N.  Y.,  March  23-25,  1916. — William  A.  Ogden,  Chairman 
Arrangement  Committee. 

Pennsylvania. 

The  fifty-third  annual  meeting  of  the  Lake  Erie  Dental  Association  will  be  held  at  Hotel 
Bartlett,  Cambridge  Springs,  Pa.,  May  18-20,  1916.— J.  F.  Smith,  120  W.  i8th  St.,  Erie, 
Pa.,  Secretary. 


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204  THS  DENTAL  DIGEST 

South  Carolina. 

The  forty-sixth  annual  meeting  of  the  South  Carolina  State  Dental  Association  will  be 
held  at  Chick's  Springs,  So.  Car.,  July  11-13,  1916.— Ernest  C.  Dye,  Greenville,  So. 
Car.,  Secretary. 

Texas. 

The  Texas  State  Dental  Association  will  hold  its  next  meeting  at  Dallas,  Texas,  May 
9-12,  1916.— W.  O.  Talbot,  Fort  Worth,  Texas,  Secretary. 

West  Virginia. 

The  next  meeting  of  the  West  Virginia  State  Dental  Association  will  be  held  at  the 
Kanawha  Hotel,  Charleston,  W.  Va.,  April  12-14,  1916.— J.  W.  Parsons,  Huntington, 
W.  Va.,  Secretary. 

Wisconsin. 

The  meeting  of  the  Wisconsin  State  Board  of  Dental  Examiners  will  be  held  at  the  Mar- 
quette Dental  College,  Cor.  9th  and  Wells  St.,  Milwaukee,  Wis.,  June  14, 1916,  commenc- 
ing at  nine  o'clock. — F.  A.  Tate,  Daniels  Blk.,  Rice  Lake,  Wis.,  Secretary, 

AMERICAN  INSTITUTE  OF  DENTAL  TEACHERS 

At  the  last  annual  meeting  of  the  American  Institute  of  Dental  Teachers  held  at  Minne- 
apolis, Minn.,  January  25-27,  1916,  the  following  officers  were  elected:  President,  Dr. 
Shirley  W.  Bowles,  1616  I  Street,  Washington,  D.  C;  Vice-President,  Dr.  John  F.  Biddle, 
517  Arch  Street,  Pittsburgh,  Pa.;  Secretary-Treasurer,  Dr.  Abram  Hoffman,  529  Franklin 
Street,  Buffalo,  N.  Y.;  Executive  Board,  Dr.  A.  W.  Thornton,  Montreal,  Canada,  Dr.  R.  W. 
Bunting,  Ann  Arbor,  Michigan,  and  Dr.  A.  D.  Black,  Chicago,  111. 

The  next  annual  meeting  will  be  held  at  Philadelphia,  January  23,  24,  25, 191 7. 

ODONTOLOGICAL  SOCIETY  OF  WESTERN  PENNSYLVANIA 

The  thirty-fifth  annual  meeting  of  the  Odontological  Society  of  Western  Pennsylvania 
will  be  held  at  the  Monongahela  House,  Pittsburgh,  Pa.,  Tuesday  and  Wednesday,  April 
II  and  12,  1916. 

The  first  regular  session  of  the  society  will  open  on  Tuesday  at  10  a.m.  The  Executive 
Council  will  meet  at  the  Hotel  at  9.30  a.m.  for  the  transaction  of  business  in  the  interest  of 
the  society.  The  clinics  and  exhibits  will  be  at  the  Monongahela  House.  Exhibitors  are 
cordially  invited  to  visit  this  meeting,  and  requested  to  make  early  reservation  for  space. 

A  cordial  invitation  is  extended  to  all  ethical  dentists  in  Pennsylvania  and  adjoining 
states. 

King  S.  Perry,  Secretary. 
719  Jenkins  Bldg.,  Pittsburgh,  Pa. 


PATENTS 

1112561,  Tooth  brush,  Edwin  H.  Rodell,  Cummings,  N.  D. 

1 112847,  Centered  mold  for  dental  castings,  Heinrich  Schweitzer,  New  York,  N.  Y. 

46510,      Design,  Sanitary  tooth  cleaner,  Edwin  G.  Over,  Fort  Worth,  Texas. 

1113752,  Dental  handpiece,  Alexander  Campbell,  Los  Angeles,  Cal. 

1 1 13325,  Implement  for  forming  metal  backs  for  artificial  teeth,  Ernest  D.  R.  Garden,  Los 

Angeles,  Cal. 
1 1 14624,  Tooth  straightening  appliance,  A.  G.  Meier,  St.  Louis,  Mo. 
1 1 14646,  Tooth  brush,  Lajos  Pap,  Arad,  Austria-Hungary. 
1114291,  Orthodontic  appliance,  Ray  D.  Robinson,  Los  Angeles,  Cal. 
1115061,  Tooth  brush  holder,  John  B.  Foster,  Newark,  N.  J. 


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FUTURE  EVBNTS  205 

m5779}  Dental  flask  and  means  for  dosing  and  fastening  the  parts  thereof,  George  Bninton, 

Leeds,  England. 
1 1 16056,  Apparatus  for  fumigating  dental  cavities,  Henri  Grasset,  Paris,  France. 
1 1 15678,  Dental  casting  apparatus,  W.  B.  C.  Kaiser,  Hamburg,  Germany. 
1116310,  Sanitary  dental  tray,  N.  A.  Maser,  Vineland,  N.  J. 
1115718,  Dental  instrument,  Wm.  H.  Mosley,  Toronto,  Ont.,  Canada. 
1 1 16868,  Saliva  ejector,  A.  A.  Anzelewitz,  New  York,  N.  Y. 
1116371,  Artificial  denture,  Ernest  C.  Bennett,  New  York,  N.  Y. 
1 1 16497,  Tooth  bridge,  Friedrich  Schreiber,  Berlin,  Germany. 
1 1 17660,  Dental  apparatus,  John  M.  Gilmore,  Chicago,  HI. 

II 17701,  Dental  syringe,  F.  L.  Piatt,  G.  N.  Hein,  and  R.  R.  Impey,  San  Francisco,  Cal. 
111727s,  Dental  impression  tray,  S.  G.  Supplee,  East  Orange,  N.  J. 

11 17276,  Taking  partial  impressions  for  artificial  dentures,  S.  G.  Supplee,  East  Orange,  N.  J. 

1 1 17277,  Heating  apparatus,  S.  G.  Supplee,  East  Orange,  N.  J. 

II 17928,  Attachment  for  dental  impression  cups,  W.  J.  Thurmond,  Columbus,  Ga. 

46650,      Design,  Tooth  brush.  Jay  Laven^on,  Philadelphia,  Pa. 

1118183,  Blowpipe  apparatus,  W.  C.  Buckham,  Jersey  City,  N.  J. 

1118301,  Filling  teeth,  Thomas  B.  Magill,  Kansas  City,  Mo. 

1118156,  Making  a  tooth  brush,  Joseph  Schoepe,  New  York,  N.  Y. 

T 1 18703,  Dental  bridgework,  George  W.  Todd,  Omaha,  Nebr. 

Copies  of  above  patents  may  be  obtained  for  fifteen  cents  each,  by  addressing  John  A. 
Saul,  Solicitor  of  Patents,  Fendall  Building,  Washington,  D.  C. 


FUTURE  EVENTS 


March  14,  1916. — Fox  River  Valley  Dental  Society,  Appleton,  Wis. — R.  J.  Chady,  Oshkosh, 

Wis.,  Secretary. 
March  20-26,  1916. — ^The  Tri-State  Post  Graduate  Dental  Meeting  (Missouri,  Kansas, 

Oklahoma),  Kansas  City,  Mo. — C.  L.  Lawkence,  Enid,  Okla.,  Secretary. 
March  23-25,  1916. — Sixth  District  Dental  Society,  Binghamton,  N.  Y.,  Hotel  Bennett. — 

William  A.  Ogden,  Chairman  Arrangement  Committee, 
March  25,  1916. — Maryland  State  Dental  Association,  Baltimore,  Md. — F.  F.  Drew,  Balti- 
more, Md.,  Secretary. 
April  4-7,  1916. — Dental  Manufacturers'  Club,  Chicago,  111.    Meeting  in  the  Banquet  Hall, 

Auditorium  Hotel. — Chairman  Exhibit  Committee,  A.  C.  Clark,  Grand  Crossing,  Chicago. 
April  II,  1916. — Alabama  Dental  Association,  Mobile,  Ala. 

April  12-14,  1916. — West  Virginia  State  Dental  Association,  Kanawha  Hotel,  Charleston. 
April  13-15,  1916. — Michigan  State  Dental  Society,  Detroit,  Michigan. — Clare  G.  Bates, 

Secretary. 
May,  1916. — Susquehanna  Dental  Association,  Scranton,  Pa. — Geo.  C.  ELnox,  30  Dime 

Bank  Bldg.,  Scranton,  Pa.,  Recording  Secretary. 
May,  1916. — Indiana  State  Dental  Association,  Claypool  Hotel,  Indianapolis,  Ind. — A.  R, 

Ross,  Secretary. 
May  2-4, 1916. — Iowa  State  Dental  Society,  Des  Moines,  la. — H.  A.  Elmquist,  Des  Moines, 

la..  Chairman  of  Exhibit. 
May  3-5, 1916. — Massachusetts  Dental  Society,  Boston,  Mass. — A.  H.  St.  C.  Chase,  Boston, 

Mass.,  Secretary. 
May  9-10,  1916. — North  Dakota  State  Dental  Association. — A.  Hallenberg,  Fargo,  No. 

Dak.,  Chairman  Exhibit  Committee. 
May  9-12, 1916. — Texas  State  Dental  Association,  Dallas,  Tex. — ^W.  O.  Talbot,  Fort  Worth, 

Tex.,  Secretary. 
May  9-12,  1916. — Illinois  State  Dental  Society,  Springfield,  111. — Henry  L.  Whipple, 

Quincy,  HI.,  Secretary. 


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206  THE  DENTAL  DIGEST 

May  11-13, 1916. — Dental  Society  of  the  State  of  New  York,  Hotel  Ten  Eyck,  Albany ,  N,  Y. 

— A.  P.  BuRKHART,  52  Genesee  St.,  Albany,  N.  Y.,  Secretary. 
May  16-18,  1916. — Nebraska  State  Dental  Society,  Lincoln,  Neb. — H.  E.  King,  Omaha, 

Neb.,  Secretary. 
May  18-20,  1916. — ^Lake  Erie  Dental  Association,  Hotel  Bartlett,  Cambridge  Springs,  Erie, 

Pa. — J.  F.  Smith,  Secretary. 
June  1-3,  1916. — Northern  Ohio  Dental  Association,  Cleveland,  O. — Clarence  D.  Peck, 

Sandusky,  O.,  Secretary. 
June  8r-io,  1916. — Georgia  State  Dental  Society,  Macon,  Ga. — M.  M.  Forbes,  Candler 

Bldg.,  Atlanta,  Ga.,  Secretary. 
June  13-15,  1916. — Connecticut  State  Dental  Association,  Hotel  Griswold,  New  London, 

Conn. — Elwyn  R.  Bryant,  New  Haven,  Conn.,  Secretary. 
June  21,1916. — Florida   State   Dental   Society,  Orlando,  Fla. — M.  C.  Izlar,  Corresponding 

Secretary. 
June  20-22,  191 6. — New  Hampshire  Dental  Society,  Lake  Sunapee,  Zoo-Nipi  Park  Lodge, 

Lisbon,  N.  H. — J.  E.  Collins,  Chairman  Exhibit  Committee. 
June   27-29,    1916. — Pennsylvania   State   Dental   Society,   Pittsburgh,   Pa. — Luther  M. 

Wea\'er,  7103  Woodland  Ave.,  Philadelphia,  Pa.,  Secretary. 
June  28-30,  1916. — North  Carolina  State  Dental  Society,  Asheville,  N.  C. — R.  M.  Squires, 

Wake  Forest,  N.  C,  Secretary. 
July  11-13, 1916. — South  Carolina  State  Dental  Association,  Chick's  Springs,  S.  C. — Ernest 

C.  Dye,  Greenville,  S.  C,  Secretary. 
July   11-13,   1916. — Wisconsin  State   Dental  Society   Meeting,  Wausau. — Theodore  L. 

Gilberton,  Secretary. 
July  12-15, 1916. — New  Jersey  State  Dental  Society,  Asbury  Park,  N.  J. — John  C.  Forsyth, 

Trenton,  N.  J.,  Secretary. 
July  25-28,  19 1 6. — National  Dental  Association,  ist  Regiment  Armory,  LouisWUe,  Ky.-  ^ 

Otto  U.  King,  Huntington,  Ind.,  Secretary. 
October  18-20,  191 6. — Virginia  State  Dental  Association,  Richmond,  Va. — C.  B.  Gifford, 

Norfolk,  Va.,  Corresponding  Secretary. 
January  23-25,  191 7. — American  Institute  of  Dental  Teachers,  Minneapolis,  Minn. — Abrau 

Hoffman,  529  Franklin  St.,  Buffalo,  Secretary-Treasurer. 


TOO  BUSY  TO  READ? 


''An  hour  with  a  book  would  have  brought  to  his  mind 
The  secret  that  took  him  a  whole  year  to  find. 
The  facts  that  he  learned  at  enormous  expense 
Were  all  on  a  library  shelf  to  commence. 
Alas!  for  our  hero;  too  busy  to  read, 
He  was  also  too  busy,  it  proved,  to  succeed. 

"We  may  win  without  credit  or  backing  or  style, 
We  may  win  without  energy,  skill  or  a  smile. 
Without  patience  or  aptitude,  purpose  or  wit — 
We  may  even  succeed  if  we're  lacking  in  grit; 
But  take  it  from  me  as  a  mighty  safe  hint — 
A  civilized  man  cannot  win  without  print.'' 

— Unknown,    Copied  from  Iowa  State  Bulletin. 


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CONTENTS  FOR  APRIL,  1916 

CONTRIBUTED  ARTICLES 

PAOB 

Shall  we  Discontinue  Devitalization  ? Walter  S.  Kyes,  D.D.S.  207 

Sugar  and  its  Effect  upon  the  Teeth John  S.  Engs,  D.D.S.  212 

A  Technique  of  Natural  Tooth  Bleaching  in  the  Mouth 

Louis  Englander,  D.D.S.  215 

Adjusting  Obturators. . . J.  E.  Kurlander,  D.D.S.,  and  H.  J.  Jaulusz,  D.D.S.  217 

Things  that  are  Said  in  Dental  Journals Hillel  Feldman,  D.D.S.  219 

Hartford  Men  Contribute  to  Forsyth  Loving  Cup 220 

New  Method  of  Constructing  Full  Dentures Clyde  Davis,  D.D.S.  221 

Indictment  Against  Dentist  Quashed 223 

First  University  Dental  School  in  New  York,  for  Columbia 225 

BUSINESS  BXnLDING 

What  Shall  We  Charge  for  Plates?  ■;226;  Proof  of  Malpractice  in  Dentistry,  234; 
Answer  to  a  Request  for  Advice,  235;  How  to  Make  a  Dentist  Happy,  238; 
The  Business  Side  of  Dentistry,  2395  The  Dentist's  Office  Hours,  241;  This 
Patient  Frankly  Leaves  the  Reward  to  God,  241;  The  Efficiency  of  the  "Trubyte 
Teeth,"  243;  Dr.  Williams  Needs  Teeth,  225. 

PRACTICAL  HINTS 244-246 

DIGESTS 

Proposed  Statements  of  Aims  and  Objects,  247;  Advice  to  Those  About  to  Wear 
Artificial  Teeth,  249. 

AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE  ..251-270 

SOCIETY  NOTES 271 

FUTURE  EVENTS 2  73 

INDEX  TO  ADVERTISING  SECTION 50 


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To  satisfy  some  old  friends,  here 
is  a  diflferent  announcement  from 
our  usual  page  featuring  Ribbon 
Dental  Cream. 


If  you  prefer  Powder — prescribe 

C0L06TE*S 

ANTISEPTIC  DENTOL  POWDER 

This  standard  powder  has  been  used  by 
numbers  of  the  profession  for  many  years, 
during  which  time  it  has  proved  itself 
well  worthy  of  the  confidence  placed 
in  it  by  those  who  prefer  a  dentifrice  in 
powder  form. 

Its  safe  chalk  "base"  free  from  harsh, 
sharp  matter  and  its  wholesome  deter- 
gent action,  are  in  keeping  with  the 
reputation  of  its  makers — a  firm  estab- 
lished over  a  century  ago. 

A  request  on  your  card  or 
letterhead  will  bring  you  a 
package  of  Ribbon  Dental 
Cream  or  Colgate's  Dental 
Powder  with  our  compli- 
ments. 

COLGATE  &  CO. 

ZBtahUahed  1806 
Dept.  21 

199  Fulton  Street,  New  York,  N.Y. 


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The  Dental  Digest 

GEORGE  WOOD  GLAPP,  D.D.Sm  Editor 

Published  monthly  by  The  Dentkts'  Supply  Company,  Candler  Bldg., 
Times  Square,  220  West  42d  Street,  >{ew  York,  U.  S.  A.,  to  whom  all  com- 
munications relative  to  subscriptions,  ^dvdrtiSiifg;  e^c,  Vtip^jld  be  addressed. 

Subscription  price,  including  postage,  %l.td  pet  ^eit  t6  all  parts  of  the 
United  States,  Phili})ptnes,  Guam,  Cuba,  »Port(^  ^^q,.  Mexica  ajid.I}ftw^iiAP. 
Islands.     To  Canada,  $^,40.     To  iV  olfit^r  cou«it^i^:$x.7S;   :•    :\  '••  ;    •     v 

Articles  intended  for  publication  arid  corresporide^nce  regarding  'tlie  Sailie  ' 
should  be  addressed  EDiTOil  t)^i5ft:AL'Di6E^T,.Candi^t"^©ldg:,;Tii|ife5  Square, 
220  West  42d  Street,  New  Yixk'^Ni'Y.  •  :'■*'"  ?,,•     vJ^'---  f  :  '•.•*  -.•' :.. 

The  editor  and  publishers  are  not  responsible  for  the  views  of  authors  ex- 
pressed in  these  pages. 

Entered  as  Second  Class  Matter,  at  the  Post-Office  at  New  York  City. 
Under  the  Act  of  Congress,  March  3,  1879. 


Vol.  XX  H 


APRIL,  1916 


No.  4 


TICLE5 


SHALL  WE  DISCONTINUE 
DEVITALIZATION? 

By  Walter  S.  Kyes,  D.D.S.,  Parser,  S.  D. 

A  number  of  yea.rs  ago  there  came  into  my  office  a  young  man  for 
whom  I  treated  and  crowned  a  lateral  incisor.  Some  time  later  he  again 
appeared  at  the  door  of  my  office  with  several  places  on  his  heretofore 
smiling  and  pleasant  visage,  badly  bruised  and  discolored  until  his  face 
seemed  almost  as  expressionless  and  quite  as  black  as  a  stove  lid.  The 
crown  of  gold  was  missing.  I  noticed  this  before  I  made  the  hasty  study 
of  the  varying  shades  of  his  countenance,  which  observation  was  probably 
due  to  the  presence  in  my  mind  of  what  might  be  termed  conunerdalism. 
When  I  speak  of  commercialism  I  mean  that  force  which,  if  not  properly 
controlled,  will  get  so  hopelessly  scrambled  with  our  ethics. 

The  young  man's  selfpossession  was  deeply  disturbed.  In  confusion 
he  inserted  his  index  finger  in  his  vest  pocket  and  took  therefrom  the 
missing  tooth.  I  did  not  ask  how  it  happened;  the  storm  clouds  on  his 
face  conveyed  to  me  the  information  more  plainly  than  could  words. 

I  seated  him  in  the  operating  chair  and  in  the  course  of  a  few  minutes 
he  gave  me  the  details  which  led  up  to  the  loss  of  the  lateral  incisor. 

It  seemed  that  since  his  previous  visit,  he  had,  through  frugality  and 
inheritance,  become  the  owner  of  a  tract  of  land.    The  correct  location  of 


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208  THE  DENTAL  DIGEST 

one  of  the  surrounding  fences  was  in  dispute,  and  in  the  effort  to  straighten 
the  matter  out  with  his  neighbor  he  had  overlooked  the  majesty  of  the 
law  and  its  innumerable  avenues  for  the  absorption  of  wealth  in  the 
settlement  of  such  cases,  and  had  made  use  of  more  convenient  and  prime- 
val  methods  at**BaliH  jt^dtoeilted  in  his  present  disfigurement. 

fitted 
a  gold 
crown  oji  aji  ^tep^F.  tootji. .  Qt^ijigi^^  J; examined  the  apex  of  the 
tootJijaiuJ  IjyasiiieUghted  to  liStejthjaJatil^^  end  of  the  root,  beauti- 

fully rounding  out  the  apex  was  the  tip  of  a  pink  guttai>ercha  point,  placed 
with  painstaking  care  exactly  where  the  college  professors  taught  us  they 
should  be  placed. 

This  was  the  first  root  canal  filling  operation  of  my  own  that  I  had 
ever  had  the  privilege  of  examining  under  such  favorable  conditions  and 
it  was  highly  gratifying  to  me,  if  not  to  my  patient. 

Just  how  many  root  canals  I  have  filled  so  well,  I  shall  never  know. 
Perhaps  the  lack  of  this  information  will  add  years  to  my  life  and  mayhap, 
happiness  to  the  years.  However,  as  time  has  passed  and  my  opportu- 
nities for  observation  have  increased,  I  have  been  deeply  impressed  with 
the  fact  that  the  roots  of  our  treated  teeth,  like  our  interproximal  spaces, 
cover  a  multitude  of  short  comings. 

After  making  this  confession,  which  I  trust  will  prove  adequate  for 
the  most  critical  minds,  I  want  to  discuss  briefly  the  substance  of  a  paper 
read  by  Henry  L.  Ulrich,  M.  D.,  before  the  Minnesota  Academy  of  Medi- 
cine, and  later  published  in  the  Journal-Lancet,  November,  1915. 

I  have  no  hope  or  desire  to  add  to  or  detract  from  the  value  of  the 
paper;  neither  shall  I  endeavor  to  corroborate  nor  contradict  any  of  the 
statements  made  there-in,  my  object  in  discussing  it  being  none  other 
than  to  get  the  matter  before  the  readers  of  the  Digest  and  making  such 
comments  as  my  experience  and  observation  as  a  practising  dentist  have 
taught  me. 

The  paper  is  entitled  "Streptococcicosis."  The  author,  taking  all  re- 
sponsibility for  the  terminology  and  giving  a  nimiber  of  reasons  forsodoing. 

The  two  main  factors  which  the  writer  states  he  wishes  to  bring  out 
in  the  study  are,  '^The  diversity  of  clinical  manifestations  of  'strepto- 
coccal focal  diseases,'  and  'The  significance  of  the  blind  apical  abscess 
in'  streptococcal  focal  diseases." 

Speaking  of  the  doctrine  of  focal  infections  the  writer  states  that,  "It 
is  the  tremendous  extent  of  distribution,  its  adaptability  to  a  variety  of 
foci,  its  protean  clinical  manifestations,  which  have  given  the  strepto- 
coccus this  important  distinction.  "Another  very  important  fact  co- 
existing with  this  doctrine  is  the  splendid  demonstration  of  the  laws  of 


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SHALL  WE  DISCONTHOTE  DBVITALIZATION?  209 

mutation,  virulence,  and  selective  actions  which  these  mutants  exercise 
in  establishing  fod. 

It  would  seem  that  these  foci  of  infection  are  established  without 
regard  for  race,  color  or  location,  being  foimd  in  all  the  organs  more  or 
less,  including  the  tonsils,  ulcers  of  the  stomach  and  the  appendix  and 
**last  but  not  least  in  importance,  the  blind  abscesses  at  the  roots  of  de- 
vitalized teeth." 

"The  root  abscess,"  continues  the  writer,  "is  far  more  important,  far 
more  significant,  than  has  heretofore  been  realized.  If  it  were  possible 
to  tabulate  all  the  fod  outside  the  respiratory  tract,  or  lUther  outside  the 
tonsils,  the  root  abscesses  of  devitalized  teeth  would  lead  the  list  by  a 
large  majority." 

"Fifty  cases  in  which  blind  apical  abscesses  were  present,  the  cultures 
of  which  abscesses  gave  types  of  streptococd,  were  analysed  as  to  age, 
sex  and  clinical  findings." 

The  author  groups  these  fifty  cases  into  five  groups  and  two  sub-groups 
three  of  which  I  will  use  for  illustration. 

1.  Rheumatoid  group  (24  cases). 

2.  Cardiovascular  group  (5  cases). 

3.  Asthenic  group  (11  cases). 

Speaking  of  the  cUnical  pathogenidty  in  group  i  the  author  states, 
"There  were  several  instances  in  which  no  results  were  obtained  by  the 
removal  of  the  tonsils  alone.  Not  until  the  dental  lesions  were  destroyed 
was  there  prompt  restitution.  Other  cases  reported  the  removal  of  the 
tonsils  and  all  other  foci  except  the  mouth  fod.  The  reduction  of  these 
again  gave  quick  response.  The  use  of  vaccines  prepared  from  bacteria 
prepared  from  apical  lesions,  gave  focal  reactions,  which  is  abundant 
proof  of  spedfidty.  In  some  instances  the  removal  of  some  of  the  fod 
of  the  mouth  gave  partial  relief.  On  removal  of  all  fod  in  the  mouth, 
including  teeth  of  a  suspicious  appearance,  complete  and  permanent 
results  were  obtained." 

In  discussing  group  2  the  author  states  that,  "The  proliferation 
action  of  streptococd  on  vascular  endotheUum  may  well  give  rise  to  a 
form  of  endarteritis  resulting  in  general  sclerosis  with  or  without  subse- 
quent hypertension."  • 

I  quote  ako  the  following  in  regard  to  gitjup  2  "The  value  of  the 
skiagraph  of  the  mouth  in  establishing  an  additional  or  remaining  depot 
of  focal  infection  in  streptococcal  disease  is  unquestioned.  The  apical 
abscess  may  be  the  only  focus  left,  the  evacuation  of  which  will  permit 
of  the  re-establishment  of  renewed  integrity  of  all  parts. 

"It  may  hold  the  balance  of  power  in  the  struggle  of  the  body  for  com- 
plete sterilization." 


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210  THE  DENTAL  DIGEST 

The  writer  then  quotes  some  figures  founded  on  his  investigations 
which  are  both  interesting  and  appalling  to  the  dental  profession. 

After  examining  the  rontgenographic  films  of  387  cases  in  which  997 
teeth  came  under  suspicion,  he  deducts  the  following.  **By  conservative 
interpretation,  737  root  abscesses  were  seen.  There  were  present  806 
artificially  devitalized  teeth,  of  these  545  had  blind  abscesses  at  the  tip 
of  the  roots,  and  191  abscesses  were  present  on  teeth  devitalized  either 
by  accident  or  pulp  destruction  by  caries."  About  the  only  consolatory 
feature  of  these  figures  is,  that  the  dental  profession  was  not  apparently 
responsible  for  the  191  abscesses  that  resulted  from  caries  and  accident. 

It  occurs  to  me  that  it  would  require  further  study  and  a  closer  analy- 
sis of  the  cases  examined  to  prove  that  our  best  efforts  in  the  matter  of 
root  canal  filling  are  wrought  with  such  calamitous  failure  and  with  such 
possible  deleterious  effects  on  the  health  of  our  clientele. 

It  is  a  well  known  fact  that  certain  practitioners  follow  out  with  vary- 
ing degrees  of  effort  and  sincerity,  certain  methods  of  pulp  devitalization 
and  root  canal  treatment. 

For  instance,  we  have  those  who  adhere  to  the  chloro-percha  and  gutta 
percha  point  method  of  root  canal  filling  under  the  protection  of  the 
rubber  dam  and  various  antiseptic  agents;  again  we  have  those  operators 
whose  proud  boast  is  that  they  have  not  had  a  roll  of  rubber  dam  in  their 
office  for  a  number  of  years  and  have  treated  teeth  continuously. 

There  are  also  a  vast  number  of  operators  who  use  the  various  mummi- 
fying agents,  with  and  without  the  use  of  the  rubber  dam. 

The  pressure  anesthesia  method  of  pulp  removal  has  a  host  of  adher- 
ents who  are  more  or  less  skilled  in  the  removal  of  pulp  debris  without  the 
rubber  dam. 

Others  are  as  equally  enthusiastic  about  the  use  of  medicated  pastes 
and  mixtures  of  medicinal  agents  for  root  canal  fillings. 

The  writer  knows  of  several  offices  where  hundreds  of  teeth  are  treated 
every  month  and  no  attempt  whatever  is  made  to  remove  the  pulp  or  to 
fill  the  root  canals. 

The  question  that  presents  itself  is,  what  method  of  treatment  and 
root  canal  filling  was  made  use  of  in  the  737  root  abscesses  observed  by 
Dr.  Ulrich? 

It  is  highly  probable  that  this  information  could  not  be  obtained  from 
cases  selected  at  random,  but  the  information  would  be  available  if  the 
cases  of  a  single  operator  using  a  particular  method  were  observed,  and  in 
this  manner  the  best  method  could  be  arrived  at,  providing  such  a  one 
exists. 

Further  elucidating  the  author  continues,  "The  prevention  of  such  ab- 
scesses entails  a  new  dental  attitude.     It  is  my  impression  that  in  the 


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POSTPONBD  ARTICLES  211 

days  when  dentists  removed  pnlpless  teeth,  the  statistics  of  chronic  rheu- 
matoid conditions  were  much  lower  than  to-day." 

The  only  way  in  which  this  impression  could  be  verified  would  be  to 
produce  the  rheumatoid  and  dental  statistics  together  with  those  covering 
the  increase  in  population  for  a  certain  period  which  is  in  all  probability 
more  difficult  than  to  fill  correctly,  a  root  canal. 

"Chronic  rheumatoid  conditions  are  decidedly  on  the  increase  and  I 
attribute  it  to  the  prevalent  custom  of  dentists  to  save  teeth,"  continues 
the  writer.  If  this  attribution  proves  true  it  will  necessarily  revise  the 
teachings  of  both  medicine  and  dentistry  in  the  matter  of  the  preservation 
of  the  teeth. 

After  stating  that  the  apical  abscess  in  his  opinion  is  hematogenous  in 
origin,  and  that  "The  devitalization  of  teeth,  which  entails  the  destruction 
of  nerve  and  blood  supply  to  the  apex  and  contiguous  bone  areas,  produces 
a  locus  resistentiae  minoris,  with  lowered  oxygen  pressure,  thereby  creat- 
ing an  ideal  nidus  for  streptococcal  growth.  We  are  compelled  by  the 
logic  of  the  situation  to  condemn  all  efforts  at  devitalization  by  dentists, 
and  strongly  to  urge  extraction  of  teeth  which  need  removal  of  pulp." 

He  then  dtes  the  findings  of  Drs.  Best  and  Da\ds  who  oppose  this 
view,  and  who  collected  135  cases  where  the  root  canal  fillings  were 
done  by  "  other  dentists."  They  reported  1 28  defective  root  canal  fillings 
with  103  abscesses.  It  is  perhaps  needless  to  here  remark  that  had  these 
investigative  gentlemen  collected  cases  from  among  their  own  clientele, 
their  contribution  to  dentistry  would  have  probably  been  of  much  more 
value. 

We  would  have  at  least  known  the  method  of  root  canal  filling  em- 
ployed and  might  have  been  a  littie  nearer  the  solution  of  the  problem. 
As  it  is,  their  investigations  only  go  to  prove  that  the  correct  filling  of  a 
root  canal  by  "other  dentists"  is  merely  an  accident  and  that  25  out  of 
128  defective  root  canal  fillings  were  not  abscessed,  which  should  at  least 
lead  us  to  believe  that  not  all  our  efforts  along  this  line  result  in  failure. 

There  is  no  questioning  the  fact  that  Dr.  Ulrich  has  thrown  a  bomb 
into  the  quietude  and  prosperity  of  our  professional  citadel  which  calls  for 
some  very  thorough  and  painstaking  investigation  on  our  part,  the  ulti- 
mate outcome  of  which  will  be  watched  with  deep  interest  by  the  medical 
as  well  as  the  dental  profession. 


POSTPONED  ARTICLES 

It  has  been  necessary  to  postpone  the  installments  of  Mr.  Supplee's 
and  Dr.  Spies'  articles  until  the  May  issue.  — The  Editor. 


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212  THE  DENTAL  DIGEST 

SUGAR  AND  ITS  EFFECT  UPON  THE  TEETH 

By  John  S.  Engs,  D.D.S.,  Oakland,  Cal. 
{Concluded  from  March  issue) 

LIME,   MAGNESIUM  AND  PHOSPHORUS 

Before  going  farther  perhaps  it  would  be  well  to  explain  that  lime 
like  all  other  elements  of  our  foods,  is  held  in  solution  in  the  blood  which 
carries  it  to  all  parts  of  the  body.  The  insoluble  calcium  phosphate  is 
believed  to  be  absorbed  by  the  blood  in  the  same  loose  chemical  com- 
bination with  a  protein  that  is  found  before  absorption  in  the  casein  of 
milk  and  the  yolk  of  an  egg.  According  to  Bunge  the  casein  and  caseino- 
gen  of  cow's  milk  contain  more  Ume  to  the  litre  than  does  lime  water. 
** Little  is  known"  he  says,  "regarding  the  form  in  which  caldimi  exists 
in  food  materials  and  at  present  differentiation  between  the  different 
groups  of  calcium  compound  eaten  cannot  be  made.  Metabolism  ex- 
periments indicate  that  a  healthy  man,  accustomed  to  a  full  diet  requires 
about  0.7  grams  of  calciimi  oxide  per  day  for  equilibrium."  Experi- 
mental dietary  studies  have  shown  that  it  is  entirely  feasible  to  increase 
largely  the  calcium  and  phosphorus  intake  by  a  more  liberal  use  of  milk 
in  the  dietary.  The  same  may  be  said  of  various  milk  products  in  which 
the  calcium  and  phosphorus  products  are  largely  or  wholly  retained, 
such  for  example  as  junket,  koumiss,  buttermilk  or  cream.  Calcium, 
magnesium  and  phosphorus  in  proper  combination  and  in  sufficient 
quantity  are  absolutely  essential  to  the  formation  of  good  bones  and 
teeth.  It  is  important  that  the  normal  amount  of  calcium  and  magne- 
sium salts  should  be  absorbed  by  the  growing  organism  during  infancy 
and  childhood,  when  the  skeleton  is  growing  rapidly.  The  absence  of 
sufficient  fat  in  the  food,  and  also  it  is  believed,  the  presence  of  a  greatly 
excessive  amount,  tends  to  deprive  the  growing  body  of  its  normal  supply 
of  calcium  and  magnesium  salts,  and  is  one  of  the  factors  in  the  produc- 
tion of  nutritional  disorders.  Phosphorus,  like  calcium,  is  an  important 
constituent  of  the  bones  of  the  active  tissues  and  also  of  the  body  fluids. 
Calcium  phosphate  is  the  chief  mineral  ingredient  of  the  bones,  and  is  sup- 
posed to  constitute  about  three-fourths  of  the  entire  ash  of  the  body.  It  is 
essential  for  the  growth  of  new  tissues  that  phosphorus  should  be  stored 
as  well  as  nitrogen.  The  importance  of  phosphorus  as  building  material 
is  strikingly  illustrated  by  nature,  in  the  way  she  provides  milk  rich  in 
that  substance  to  the  young  of  rapidly  growing  animals.  Not  only  do 
these  salts  enter  into  the  structure  of  bones  and  teeth,  but  their  presence 
in  sufficient  quantity  in  other  tissues  is  absolutely  essential,  to  insure  the 


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SUGAR  AND  ITS  EFFECT  UPON  THE  TEETH  213 

normal  functional  activities  of  the  most  important  organs  of  the  body, 
particularly  the  heart.  So  we  see  that  anything  tending  to  reduce  the 
normal  amount  of  these  three  substances  available  in  the  blood  stream 
not  only  has  a  detrimental  influence  upon  the  osseous  system  of  the  body, 
but  is  also  likely  to  have  its  effect  upon  the  very  seat  of  vitality  itself. 

ITS   AFFINITY   FOR   LIME 

Someone  has  said  that  refined  sugar  possesses  a  strong  affinity  for  Ume, 
and  when  present  in  large  quantity  in  solution  in  the  blood  stream,  it 
causes  a  reduction  in  the  available  lime  in  the  blood  by  combining  with 
it  to  form  sucrates  of  lime,  so  that  if  food  containing  sufficient  lime  is 
not  taken  with  our  daily  meals  to  maintain  the  proper  balance,  the  blood 
to  preserve  that  balance  is  forced  to  extract  it  from  that  supply  which  is 
stored  up  in  the  bones  and  teeth  thus  weakening  their  structure.  This 
seems  quite  plausible,  though  it  is  not  what  we  may  call  a  scientific  state- 
ment; nor  does  it  satisfy  the  minds  of  deeper  thinkers.  It  has  also  been 
suggested  that  the  blood  may  become  supersaturated  with  the  sugar  in 
solution  that  is  consumed  in  excess  of  the  body  needs,  and  that  the  blood 
being  thus  surcharged  has  no  room  for  other  food  elements  required  by 
the  tissues,  consequently  they  are  starved.  That  the  teeth  can  be  thus 
affected  will  entail  the  belief  that  nourishment  of  the  teeth  goes  on  after 
they  are  fully  formed — a  fact  that  some  of  the  more  eminent  educators 
like  Black,  deny. 

METABOLISM  IN  DENTIN 

The  word  metabolism  is  used  to  designate  both  that  building  up  and 
breaking  down  of  tissue  which  biologists  express  respectively  by  the 
terms  anaboUsm  and  catabolism.  Prof.  Torrey  of  Reed  College  assures 
me  that  both  processes  go  on  together  in  all  tissues.  The  cataboKc 
are  particularly  obvious  in  old  age,  the  anabolic  particularly  obvious 
in  youth.  He  does  not  consider  '*old  age  a  bacterial  matter."  It 
seems  to  him  to  be  '*a  definitely  metabolic  affair;  the  balance  shifting 
from  a  generally  uphill  to  a  generally  downhill  course."  Having  fairly 
good  evidence  of  a  constructive  metabolism  in  those  cases  of  hyperdenti- 
fication  that  we  frequently  find  upon  examination  of  teeth  subject  to 
external  stimuli — bearing  in  mind  this  fact,  that  both  the  building  up 
process  and  the  breaking  down,  are  subject  to  influences  that  tend  to 
throw  the  balance  one  way  or  the  other,  is  it  not  probable  that  some  such 
cause,  as  lack  of  proper  nutrition,  would  be  likely  to  shift  the  balance 
towards  the  breaking  down  side,  and  thus  cause  either  decalcification  or 
degeneration  of  tissue  in  the  dentin? 

That  changes  in  the  structure  of  dentin  do  occur  in  completely  formed 
teeth,  is  shown  in  the  hyperdentification  that  results  from  external  stimu- 


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214  THB  DENTAL  DIGEST 

lation  to  which  they  are  subjected  for  long  periods  of  time.  We  do  not 
know  how  or  where  the  lime  employed  was  obtained,  suffice  it  to  say, 
that  some  means  of  conveyance  exists.  I  contend  that  if  lime  can  be 
deposited 'in  formed  dentin,  means  for  its  removal  are  likewise  possible, 
should  the  occasion  arise. 

Dr.  Harvey  W.  Wiley  in  response  to  a  letter  from  me,  said  amongst 
other  things,  '1  am  glad  to  note  that  the  dentists  of  the  country  are  be- 
ginning to  understand  that  bad  teeth  are  largely  due  to  faults  of  meta- 
bolism, rather  than  exclusively  to  heredity  and  lack  of  care."  He  said 
also  in  a  previous  communication,  "  I  do  not  believe  that  dentists  can  long 
hold  to  the  fact  that  bacterial  activities  are  the  sole  cause  of  dental  decay. 
A  condition  of  acidosis  in  the  body  would  probably  be  more  effective  in 
causing  decay  of  the  teeth  than  bacterial  activity." 

In  1894  Dr.  W.  G.  A.  Bonwill  read  before  the  N.  Y.  Odontological 
Society  a  paper  entitled  **A  New  Era  in  Dental  Practice."  I  quote 
from  it — "  Medical  men  can  well  ask  for  preventive  medicine,  for  every 
honest  M.D.  soon  learns  to  give  less  and  less  medicine," — *^We,  as 
dentists  have  an  entirely  different  field,  for  we  have  millions  coming  to 
us  where  no  law  of  prevention  can  be  applied.  We  can  only  save  and 
restore  the  lost  structure  by  our  cunning  and  art."  *'But  there  is  much 
that  can  be  done  to  check  caries  in  its  very  indpiency,  and  that  without 
fiUing." 

**  If  we  must  link  ourselves  at  all  with  the  medical  men,  let  us  emulate 
their  example  in  one  thing  at  least — anticipative  medicine  or  as  they 
have  it,  preventive  medicine." 

While  it  is  true  there  are  "millions  coming  to  us,"  whose  teeth  have 
yielded  so  much  to  the  ravages  of  decay  that  there  seems  no  hope  of 
saving  them,  yet,  in  the  light  of  modern  research  and  results  obtained 
in  the  last  few  years,  I  think  if  we  could  have  Dr.  Bonwill  with  us  to- 
day, he  would  not  have  to  say,  that  *'no  law  of  prevention"  can  be  ap- 
plied to  them. 

If  we  can  but  bring  ourselves  to  consider  teeth  in  the  same  light  that 
we  do  other  tissues  of  the  body,  subject  to  structural  change  and  under 
the  influence  of  those  centres  that  control  nutrition,  then  I  think  we  shall 
find  a  way  and  a  means,  to  arrest  decay  in  teeth  already  attacked,  and  to 
prevent  it  by  care  in  the  selection  of  food  for  our  growing  children,  seeing 
to  it  that  their  food  furnishes  all  the  necessary  tooth  building  elements, 
calcium,  phosphorus  and  magnesium  in  particular,  which  are  found  in 
available  form  in  milk,  greens  (fresh  or  cooked),  vegetables  of  all  kinds, 
the  unprocessed  cereals  and  fruits  and  substituting  these  for  sugar,  white 
bread  and  cake. 

Encourage  the  manufacturers  to  produce  pure,  unadulterated  food 


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A  TECHNIQUE  OF  NATURAL  TOOTH  BLEACHING  IN  THE  MOUTH    215 

preparations,  by  personally  demanding  them  of  your  dealer  in  preference 
to  the  ready  cooked,  ready  chewed  and  predigested  truck  that  is  made 
for  lazy  people. 

If  we  suflfer  from  tooth  decay  or  any  ailment  of  the  teeth  either  we  or 
our  parents  are  largely  to  blame,  nine  times  out  of  ten.  We  are  given 
teeth  to  use  in  masticating  our  food,  not  entirely  for  ornament,  and 
many  of  us  have  forgotten  how  or  have  never  learned  to  use  them.  We 
have  glands  that  secrete  digestive  juices  but  no  time  is  given  those  juices 
to  act,  food  is  washed  down  into  the  stomach  by  a  deluge  of  liquid  taken 
after  each  mouthful  of  food  before  it  is  properly  broken  up  and  mixed 
with  the  saliva. 

An  extra  burden  is  thus  thrust  uix)n  the  stomach,  and  semi-digested 
food  lies  fermenting  in  the  bowels  giving  off  poisonous  elements  that 
little  by  little  lay  the  foundation  for  our  old  acquaintance,  pyorrhoea 
alveolaris. 


A  TECHNIQUE  OF  NATURAL  TOOTH  BLEACHING 
IN  THE  MOUTH 

By  Louis  Englander,  D.D.S.,  Philadelphia,  Pa. 

The  restoration  and  maintenance  of  a  natural  live  tooth  appearance  in 
a  discolored,  devitalized  tooth  is  a  procedure  which  has  been  overlooked 
to  a  large  degree  by  the  dental  practitioner. 

Esthetically,  to  keep  a  tooth  life-like  is  a  necessity.  Especially  is  this 
true  of  the  anterior  teeth.  Upon  it  depends  in  a  large  measure,  the  suc- 
cess of  a  porcelain  inlay  or  a  synthetic  filling.  Dentists  hesitate  to 
attempt  the  bleaching  of  the  teeth,  believing  that  it  is  only  temporary 
and  that  the  discoloration  will  return. 

To  know  the  cause  of  the  discoloration  will  aid  in  the  permanent  re- 
storation of  the  color.  The  enamel  is  composed  almost  entirely  of  inor- 
ganic matter  and  is  translucent.  It  is  the  dentine  which  gives  the  shade 
or  color  to  the  teeth.  The  dentine  is  composed  of  a  solid  organic  matrix 
containing  a  large  percentage  of  inorganic  matter.  This  is  pierced  by 
minute  canals  or  tubules  which  radiate  from  a  central  cavity.  The 
minute  canals  or  dentinal  tubules  are  occupied  in  life  by  protoplasmic 
processes  from  the  odontoblastic  cells  which  form  the  outer  layer  of  the 
pulp.  It  is  in  these  tubules  that  the  discoioratioa  occurs,  and  into  which 
the  bleaching  agent  must  penetrate. 

The  discoloration  of  dentine  is  due  to  three  causes;  hemoglobin,  me- 


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2t6  THE  DENTAL  DIGEST 

tallic  and  carious.  When  extirpating  the  pulp,  espedally  if  the  tooth 
has  been  opened  from  the  side  or  back,  care  must  be  taken  that  all  of  the 
hom  of  the  pulp  is  removed.  Any  blood  resulting  from  an  apical  hem- 
orrhage and  all  carious  d6bris  must  be  thoroughly  removed  mechanicaUy. 
\fter  this  has  been  accomplished,  we  may  then  enter  upon  the  bleaching 
of  the  tooth. 

As  a  bleaching  agent,  the  writer  has  found  that  either  Dioxygen  or 
Perhydrol  is  the  most  convenient  and  satisfactory  to  use,  and,  if  manipu- 
lated proi>erly,  success  will  result  in  all  cases.  In  using  Dioxygen  place 
about  one  and  one  half  fluid  drams  of  the  H2O  in  a  test  tube  and  heat 
slowly  over  a  small  flame  of  a  Bunsen  burner,  holding  the  test  tube  at  an 
angle  of  about  30  degrees,  and  concentrate  the  fluid  to  about  10  minims. 
Some  of  this  is  then  placed  in  the  tooth  cavity  on  a  small  pledget  of  cotton. 
Several  blasts  of  hot  air  are  blown  upon  it  in  the  direction  of  the  greatest 
discoloration.  Repeat  this  operation  two  or  three  times.  Where  a 
compressed  air  blast  is  used,  be  very  careful  not  to  direct  the  hot  blast 
against  the  enamel  too  long,  as  it  will  burn  the  enamel  and  produce  a 
brown  discoloration  which  cannot  be  removed.  If  the  color  is  not  re- 
stored at  one  sitting,  place  a  pledget  of  cotton  containing  the  concen- 
trated H2O2  in  the  cavity  and  seal  it  up  with  temporary  stopping  or 
cement.  Have  the  patient  return  in  about  five  days  and  the  improve- 
ment in  color  will  be  manifest.  In  case  the  restoration  of  shade  has  not 
been  complete,  repeat  the  operation.  Three  such  treatments  usually 
suffice. 

Perhydrol  (Merck)  is  about  30°  H2  O2  by  weight,  and  has  the  advan- 
tage over  Dioxygen  in  that  it  can  be  appUed  without  boiling.  Should 
the  Perhydrol  become  weaker  through  age,  it  can  be  boiled  and  the 
strength  regained.  In  using  either  Dioxygen  or  Perhydrol,  it  is  advisable 
to  place  the  rubber  dam  over  the  tooth  to  be  bleached,  and  also  to  be 
careful  not  to  get  any  on  the  fingers,  as  these  strong  bleaching  agents 
attack  the  tissues.  Never  apply  either  of  these  strong  medicants  to  a 
vital  tooth. 

Now  that  the  dead  tissue  in  the  dentinal  tubules  has  been  bleached, 
and  the  desired  color  restx)red,  the  tooth  should  be  wiped  out  with  alcohol, 
thoroughly  dried,  and  a  light  yellow  cement  placed  directly  against  the 
dentine,  which  will  seal  the  tubules.  For  this  I  have  found  Harvard 
Cement  No.  4  most  suitable.  The  tooth  can  then  be  filled  with  whatever 
material  desired. 

I  have  cases  under  my  observation  which  were  treated  in  this  manner 
more  than  eight  years  ago,  and  they  still  have  the  same  live  tooth  appear- 
ance. 


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ADJUSTING  OBTURATORS 


217 


ADJUSTING  OBTURATORS 

By  J.  E.  KuRLANDER,  D.D.S.  AND  H.  J.  Jaulusz,  D.D.S. 
Cleveland,  O. 

In  making  and  adjusting  obturators  to  remedy  the  inconvenience  of 
patients  afflicted  with  cleft  palate,  not  only  should  the  dentist  know  the 
history  of  the  patient  and  the  causes  which  bring  about  this  condition, 
but  by  careful  study  of  the  case  in  hand  he  should  form  some  idea  of  the 
part  which  the  five  pairs  of  muscles  controlling  these  parts  play  in  their 
impaired  physiological  functions.  These  muscles  as  well  as  those  of  the 
tongue,  the  hyoid  bone  and  the  pharnyx,  take  part  in  deglutition,  pre- 
venting the  food  from  passing  into  the  larynx  and  nasal  cavity  and  in 
forcing  the  same  into  the  oesophagus  in  the  act  of  swallowing. 


Elus.  No.  I.    Impression  of  cleft  in  plaster 

Cleft  palate  may  be  divided  into  two  classes,  namely,  congenital  and 
acquired.  The  first  or  congenital  is  brought  about  either  from  deficiency 
in  the  supply  of  lime  salts  to  the  maxillae  of  the  foetus,  thereby  produc- 
ing malformation  of  the  parts  and  that  in  the  absence  of  any  diseased 
condition  brought  about  by  syphilitic  taint  on  the  part  of  the  parents. 
Acquired  cleft  palate  is  brought  about  by  wounds  inflicted  on  the  parts, 
as  well  as  from  niunerous  other  causes.  In  the  case  under  consideration, 
the  cleft  in  the  palate  was  due  to  hereditary  syphilis. 

The  patient,  a  young  man  22  years  of  age,  came  to  me  with  a  V- 
shaped  cleft  which  widened  posterially,  the  uvula  and  about  two-thirds 
of  the  palate  processes  of  the  superior  maxillae  being  absent.  His 
speech  was  so  indistinct  that  it  was  with  diificulty  that  he  could  be  under- 
stood when  talking,  the  sound  passing  through  the  nose.  He  was  also 
greatly  annoyed  by  food  passing  through  the  deft  into  the  nasal  fossae 
during  mastication  and  deglutition. 


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218 


THE  DENTAL  DIGEST 


nius.  No.  2.    Gold  crowns  adjusted  to  the  two  superior  bicuspids  with  platinum  posts 

soldered  on 


Dlus.  No.  3.    Side  view  of  obturator,  showing  hinge 


Illus  Nq-  4-    View  of  plaster  model  with  obturator  in  place 

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THINGS  THAT  ARE  SAID  IN  DENTAL  JOURNALS  219 

T  first  took  an  impression  of  the  cleft  in  plaster;  removing  this  I  filled 
the  deft  with  soft  wax  and  took  a  plaster  impression  of  the  mouth. 
Having  taken  these  two  impressions,  I  made  and  adjusted  gold  crowns 
to  the  two  superior  second  bicuspids — to  the  palatine  surface  of  each  of 
which  a  platinum  post  about  an  inch  in  length  was  soldered.  Taking 
another  impression  with  the  crowns  adjusted,  I  made  a  model  of  same 
and  casting  an  aluminum  plate  formed  grooves  in  the  palatine  surface  of 
it,  in  which  the  posts  on  the  crowns  would  fit,  and  which  helped  to  sup- 
port the  plate  in  position. 

I  next  made  an  extension  to  the  plate  to  fill  in  the  cleft  posterior  to 
it  and  to  substitute  the  absent  uvula,  making  the  same  of  aluminum, 
which  was  also  cast.  I  made  a  gold  hinge,  one-half  of  which  was  vul- 
canized to  the  heel  of  the  plate  and  the  other  half  to  the  anterior  edge  of 
the  extension.  On  the  anterior  palatine  edge  of  the  extension  was  a  pro- 
jection of  aluminum,  which  when  the  plate  and  the  extension  was  in  the 
mouth,  caught  on  the  end  of  the  gold  post  which  was  vulcanized  to  the 
palatine  surface  of  the  heel  of  the  plate,  and  thereby  prevented  the  forc- 
ing of  the  extension  by  the  muscles  too  far  into  the  post  nasal  vault. 
The  protection  which  this  applicance  when  in  position  afforded  the  pa- 
tient in  mastication  and  deglutition  were  complete,  and  his  speech  was  so 
greatly  corrected  that  he  could  be  plainly  understood  when  talking,  and 
he  was  transformed  from  the  village  fool,  as  he  was  called,  to  a  man 
whose  speech  was  so  fully  corrected  as  to  render  any  impediment  in  it 
scarcely  noticeable. 

2496  E.  9th  St. 


THINGS  THAT  ARE  SAID  IN  DENTAL  JOURNALS 

By  Hillel  Feldman,  D.D.S.,  Bronx,  N.  Y. 

It  seems  there  is  no  limit  to  the  things  that  some  professional  men  can 
get  themselves  to  say  in  a  Dental  Journal. 

In  the  January  issue  of  the  Dental  Digest  "W.B.B."  asks  "what  is 
the  best  thing  to  do  for  a  child  three  years  old  who  breathes  through  the 
mouth  nights  and  snores  as  loud  as  an  adult?  " 

In  the  February  issue  followed  a  short  note  in  answer  to  ''W.B.B." 
from  the  pen  of  **Levi  C.  Taylor"  which  is  the  cause  of  my  writing  this. 

The  February  correspondent  gives  "W.B.B."  the  very  elegant  coun- 
sel of  binding  the  child's  lips  with  adhesive  plaster,  '*  tight,"  so  that  the 
child  will  be  compelled  to  breathe  through  the  nose!  Presto!  Doesn't 
that  solve  the  question?    Truly  ''the  pen  is  mightier  than  the  sword"! 


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220  THB  DENTAL  DIGEST 

(Why  not  melt  paraffine  over  the  adhesive  plaster  so  as  to  make  an  herme- 
tical  seal  out  of  the  operation?)  In  the  morning,  behold,  Levi  C.  Taylor 
says  *^you  remove  the  adhesive  plaster  by  taking  hold  of  one  comer." 
Isn't  that  an  advance  in  scientific  research? 

I  sometimes  wonder  why  the  medical  professional  holds  in  such  light 
esteem  the  members  of  the  dental  profession.  How,  pray,  can  I  censure 
them  when  they  read  such  edifying  epistles  from  dentists  as  the  reply  to 
''W.B.B."? 

If  W.B.B.'s  patient  breathes  through  the  mouth  at  night,  a  good 
rhinologist  should  be  consulted.  The  latter  may  find  it  necessary  to 
further  invite  into  the  consultation,  an  orthodontist.  I  am  sure  it  is  a 
simple  physical  defect  that  can  be  remedied.  But  until  it  is  remedied  the 
child's  breathing  should  not  be  interfered  with  by  any  such  outlandish 
methods  as  plastering  up  the  mouth.  Breathing  through  the  mouth  is 
not  a  voluntary,  acquired,  habit,  but  rather  a  condition  forced  upon  in- 
dividuals by  physical  imperfection  of  the  naso-pharynx,  constriction  of 
the  ajtiterior  nares  with  attendant  constriction  of  the  bones  of  the  anterior 
area  of  the  face,  or  from  deflected  nasal  septum,  to  say  nothing  of  the 
presence  of  adenoid  growths  in  the  posterior  passages. 


HARTFORD  MEN  CONTRIBUTE  TO  FORSYTH  LOVING  CUP 

In  an  editorial  in  the  Oral  Hygiene  magazine,  edited  by  W.  W.  Belcher, 
D.D.S.,  of  Rochester,  an  article  appeared  asking  that  all  dentists  send 
not  over  25  cents  for  the  purchase  of  a  loving  cup  to  be  presented  to 
Thomas  A.  Forsyth,  as  a  testimonial  of  the  esteem  in  which  he  was  held 
by  the  dentists. 

A  list  of  the  dentists  in  Hartford  was  prepared  and  presented  to  each 
as  far  as  known.  If  all  the  dentists  in  our  different  cities  and  towns 
respond  as  quickly  and  in  such  numbers  as  the  city  of  Hartford,  the 
loving  cup  will  certainly  be  presented  to  Dr.  Forsyth  very  shortly. 


Editor  Dental  Digest: 

Can  any  of  your  readers  give  a  remedy  for  a  baby  sucking  her  lips? 
JS. 

Editor  Dental  Digest: 

Will  some  of  your  readers  please  give  a  formula  for  cleaning  impres- 
sion trays? 

Perplexed. 


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NEW  METHOD  OF  CONSTRUCTING  FULL  DENTURES  221 

NEW  METHOD  OF  CONSTRUCTING  FULL  DENTURES 

By  Clyde  Davis,  D.D.S.,  Lincoln,  Nebraska 

I  have  a  method  which  I  wish  to  give  the  dental  profession  for  its 
consideration,  of  constructing  a  full  denture,  either  single  or  double,  that 
I  have  never  read  of  and  I  believe  the  idea  or  the  application  of  the  idea 
is  original.  I  have  tried  it  out  in  our  infirmary  and  proven  that  it  is 
possible  to  get  suction  for  all  plates,  both  upper  and  lower,  in  every  in- 
stance where  the  mouth  approaches  normal. 

Stated  in  a  nutshell,  the  method  involves  the  complete  abandonment 
of  the  model  of  the  mouth  and  the  plate  is  vulcanized  on  a  cast  which 
is  the  negative  of  an  adhering  base  plate.  Given  as  briefly  as  possible 
the  method  is  as  follows. 

An  impression  is  taken  of  the  mouth  and  the  cast  made,  which  should 
be  somewhere  near  correct,  but  it  is  not  necessary  to  take  any  great 
pains  with  it.  It  should  give  the  outline  of  the  completed  plate  and  par- 
tially represent  the  conditions  of  the  mouth.  In  fact,  in  some  instances 
even  this  is  not  necessary  provided  you  have  a  dummy  cast  of  plaster, 
metal  or  celluloid,  which  is  somewhere  near  the  size  of  the  mouth,  but 
should  be  a  trifle  larger  in  every  direction.  Having  secured  an  approx- 
imately correct  model  a  specially  prepared  base  plate  which  is  very  thin 
and  when  warm  is  very  pliable,  is  readily  shaped  over  this  model.  This 
base  plate  will  probably  not  show  suction  when  placed  in  the  mouth  and 
pressed  to  position.  If  it  is  far  wrong,  take  it  out,  warm  it  over  a  flame 
and  press  to  place  in  the  mouth.  As  soon  as  a  little  suction  begins  to 
show  up,  instruct  the  patient  to  keep  the  mouth  closed  and  suck  the 
plate  as  tightly  as  possible.  The  warmth  of  the  mouth  will  change  this 
until  close  adaption  results  and  strong  suction  will  appear.  This  may  be 
assisted  by  manipulating  with  the  fingers  and  it  is  particularly  necessary 
with  the  trial  base  plate  on  the  lower  jaw.  When  this  suction  has  been 
secured  it  will  be  found  that  this  trial  plate  will  not  fit  the  original  cast 
even  though  it  is  a  perfect  model  of  the  mouth.  It  will  be  found  that  no 
impression  of  the  mouth  can  be  taken  which  this  adhering  base  plate 
will  fit,  which  proves  my  contention  of  the  past  twenty  years,  that  a 
plate  made  from  a  perfect  cast  of  the  mouth  seldom  has  adhesion.  I  have 
always  spoiled  my  casts  up  to  this  time  in  order  to  get  adhesion.  Now  I 
am  asking  you  to  throw  them  away  altogether. 

Coming  back  to  the  case  where  you  have  one  or  both  adhering  trial 
base  plates  in  the  mouth,  I  then  take  the  bite  in  the  usual  way  for  that 
kind  of  a  case  using  the  built  up  bite  on  these  base  plates.  Plaster  of 
Paris  is  then  mixed  up  ready  for  use  and  the  trial  plates  hastily  removed 


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222  THE  DENTAL  DIGEST 

from  the  mouth  and  filled  with  plaster.  These  are  then  mounted  on  the 
articulator  and  the  case  proceeds  in  the  usual  way.  In  these  casts  which 
are  poured  up  you  have  the  negative  of  an  adhering  base  plate  which . 
is  by  no  means  a  model  of  the  mouth.  Every  plate  made  by  this  method, 
both  upper  and  lower,  adheres  as  would  the  trial  base  plates.  This  method 
of  making  an  adhering  denture  without  vulcanizing  on  a  cast  of  the  mouth 
has  many  side  issues  which  I  haven't  time  to  go  into  at  present.  SuflSce 
it  to  say  that  by  this  method  we  can  construct  a  denture,  if  necessary/ 
without  having  taken  an  impression  of  the  mouth,  using  an  approximate 
dijjnmy  to  start  the  shape  of  the  base  plate,  completing  its  form  in  the 
mouth  assisted  by  the  body  temperature  which  must  slightly  affect  the 
specially  prepared  base  plate.  The  plaster  which  is  poured  into  these 
adhering  base  plates  should  be  a  little  below  body  temperature  in  order 
that  they  may  not  give  and  change  shape  under  the  weight  of  the  poured 
in  model.  The  base  plates  should  be  given  a  thin  coat  of  quickly  drying 
ether  varnish,  before  pouring  the  plaster  and  then  painted  over  with  a 
very  thin  solution  of  soap.  This  gives  a  smooth  cast  and  the  base  plate 
by  warming  can  be  easily  removed  from  the  cast.  This  matter  can  be 
tested  out  by  anyone  if  they  will  try  the  base  plate  back  in  the  mouth 
after  it  has  been  removed  from  this  cast  and  it  will  be  found  that  the 
adhesion  is  still  there.  If  you  will  take  the  base  plate  and  warm  it  and 
place  in  over  the  original  cast  of  the  mouth  and  press  it  into  place  and 
then  try  it  in  the  mouth,  it  will  be  found  that  the  adhesion  has  been  de- 
stroyed. Allow  this  base  plate  to  remain  in  the  mouth  and  get  warm,  and 
adhesion  again  takes  place.  Taking  it  out  of  the  mouth  it  will  be  found 
to  fit  the  cast  which  has  been  poured  into  the  base  plate  and  does  not  fit 
the  cast  of  the  mouth. 

You  will  see  more  about  this  method  later  on. 

University  of  Nebraska 


CARE  AND  USE  OF  THE  TOOTH  BRUSH 

Pour  boiling  water  on  your  brush  occasionally.  Keep  it  in  a  large 
mouth  bottle  in  which  you  have  a  saturated  solution  of  boric  acid  Make 
new  solution  once  a  week.  Request  your  patients  to  bring  their 
brushes  to  the  office  with  them  and  you  take  the  brush,  holding  it  prop- 
erly in  your  own  hand,  and  brush  their  teeth.  You  can  teach  them 
the  correct  use  of  the  brush  no  other  way  so  well.  Be  very  sure  you 
are  capable  of  teaching  this  important  truth.  It  is  an  acknowledged 
fact  that  improper  use  of  the  brush  is  but  little  better,  if  any,  than  no 
use  at  all. 

J.  M.  Prime. 


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INDICTMENT  AGAINST  DENTIST  QUASHED  223 

INDICTMENT  AGAINST  DENTIST  QUASHED 

{Federal)  The  vigilance  of  the  government  in  putting  an  end  to  the 
drug  trafl&c  in  the  United  States  is  presented  in  a  large  variety  of  recent 
cases.  Among  them  the  case  of  United  States  v,  Freedman  stands  out 
prominently.  Defendant  Freedman,  a  dentist  was  indicted  for  having 
dispensed  morphine  sulphate  in  other  than  the  regular  course  of  his  pro- 
fessional practice,  that  is  to  say  he  used  the  drug  in  quantities  more  than 
was  necessary  for  a  patient's  use. 

The  defense  interposed  was  that  the  law  contained  no  language 
governing  the  question  of  necessary  quantity.  The  law  in  specific  terms 
enumerates  the  requirements  imposed  on  those  who  handle  the  drug  in 
making  a  sale,  such  as  filing  a  dupKcate  with  the  Commissioner  of  Internal 
Revenue,  etc.,  but  nothing  is  said  with  relation  to  selhng  or  using  the 
drugs  in  quantities  more  than  necessary  to  meet  the  needs  of  a  patient. 

The  court  quashed  the  charges  against  the  defendant.  Quoting  the 
court,  Judge  McCall  said:  "I  fail  to  find  in  the  act  of  Congress  under 
examination  any  language  making  the  doing  of  the  things  with  which 
the  defendant  is  charged  a  violation  of  law.  In  other  words,  there  is  no 
limit  fixed  to  the  amount  of  said  drugs  that  a  physician,  druggist  or 
dentist  may  prescribe,  nor  is  there  any  duty  imposed  upon  him,  and  the 
name  and  address  of  the  patient,  except  those  to  whom  he  may  personally 
administer,  and  that  he  must  preserve  the  records  of  two  years.  For 
failing  to  do  either  of  these  things  he  is  not  indicted."  The  indictment 
was  quashed.     (United  States  v.  Freedman,  224  Fed.  276.) 

EXCLUSION  OF  POISON  FROM  MAILS 

(Federal)  Post  Office  Department  Order  No.  2923  by  the  Post- 
master General  prohibiting  the  mailing  of  poisonous  compositions  except 
for  transmission  in  the  domestic  mails  from  manufacturer  or  dealer 
to  licensed  physicians,  surgeons,  pharmacists^  and  dentists,  held  invaUd, 
as  beyond  the  jurisdiction  of  the  Postmaster  General.  (Bruce  v.  United 
States,  120  C.  C.  A.  370.) 

VETERINARY  DENTISTS   AMENABLE   TO  THE   GENERAL  DENTAL  LAWS 

(North  Dakota)  The  North  Dakota  Supreme  Court  has,  by  a  recent 
decision,  held  veterinary  dentists  to  be  subject  to  the  North  Dakota 
Laws  having  application  to  other  dentists.  It  is  quite  clear  that  the 
legislative  intent  was  to  afford  to  animals  the  same  degree  of  surgical 
skill  as  is  by  the  state  dental  laws  guaranteed  to  man.  The  defendant  in 
State  V.  Ramsey  was  convicted  in  the  County  Court  of  Cass  County  of 
the  crime  of  wilfully  and  unlawfully  practising  veterinary  dentistry  with- 


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224  THE  DENTAL  DIGEST 

out  a  license.  He  was  a  student  under  a  Doctor  Milan.  It  seems  that 
defendant  performed  all  dental  work  under  Doctor  Milan,  doing  the 
mechanical  work  such  as  extracting  teeth  and  filling  them. 

Defendant's  contention  was  that  he  was  immune  from  the  law  in 
view  of  the  fact  that  he  was  not  engaged  in  the  profession  of  dentistry 
as  conmionly  understood  but  in  the  profession  of  veterinary  dentistry 
and  that  as  the  law  makes  no  specific  reference  to  veterinary  dentistry 
it  was  not  intended  to  have  any  application  to  such  profession. 

The  defendant  was  convicted  in  the  trial  court  it  having  been  held 
that  he  was  subject  to  the  general  dental  laws.  On  appeal,  the  Supreme 
Court  affirmed  the  holding  of  the  lower  court.  (State  v,  Ramsey,  154 
N.  W.  732.) 

FRAUD   ON  MEDICAL  EXAMINERS  PUNISHABLE 

(Iowa)  The  Iowa  Code  provides  that  any  person  who  shall  present 
to  the  board  of  medical  examiners  a  fraudulent  or  false  diploma,  or  one 
of  which  he  is  not  the  rightful  owner,  for  the  purpose  of  securing  a  certi- 
ficate permitting  him  to  practise  medicine  or  dentistry  or  shall  file  or 
attempt  to  file  with  the  county  recorder  the  certificate  of  another  as  his 
own,  or  who  shall  falsely  personate  any  one  to  whom  a  certificate  has 
been  granted,  or  who  shall  practise  medicine,  surgery,  or  obstetrics  or 
dentistry  without  obtaining  and  filing  the  required  certificate,  or  who 
continues  to  so  practise  after  the  revocation  of  his  certificate,  shall  be 
guilty  of  a  misdemeanor. 

Under  this  law  one  Charles  Edmund  was  indicted  for  having  loaned 
his  certificate  to  a  fellow  named  McAninch.  McAninch  proposed  to 
practise  under  such  certificate.  Edmund  and  McAninch  were  both 
tried  and  convicted  in  the  same  trial.  This  Edmund  claimed  to  be  error 
on  the  part  of  the  trial  court.  The  Supreme  Court  on  reviewing  the  case 
however  held  that  such  procedure  was  regular.  (State  v.  Edmund,  154 
N.  W.  473.) 

LICENSE   LAW  CONSTITUTIONAL 

(Wisconsin)  The  statute  providing  for  the  licensing  of  all  persons 
practising  medicine,  surgery,  dentistry  or  osteopathy  for  fee  or  compensa- 
tion and  imposing  a  fine  for  practising  without  a  license  is  constitutional 
and  within  the  legislative  power.     (Arnold  v,  Schmidt,  143  N.  W.  1055.) 

SELLING  MORPHINE  WITHOUT  PRESCRIPTION 

(Georgia)  One  who  sells  morphine  not  on  the  order  of  a  licensed 
physician,  dentist,  or  veterinary  surgeon,  is  guilty  of  a  misdemeanor, 
whether  he  is  the  proprietor  of  the  drug  store,  or  merely  the  employee  of 
such  proprietor.     (Oppenheim  v.  State,  77  S.  E.  652.) 


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FIRST  UNIVERSITY  DENTAL  SCHOOL  FOR  COLUMBIA  225 

FIRST  UNIVERSITY  DENTAL  SCHOOL  IN 
NEW  YORK  FOR  COLUMBIA 

Dental  Course  to  be  Allied  with  College  of 
Physiclans  and  Surgeons 

Realizing  the  importance  of  the  teeth  and  mouth  infections  to  sys- 
temic disease,  the  Faculty  of  the  College  of  Physicians  and  Surgeons  have 
unanimously  voted  in  favor  of  the  establishment  of  a  dental  department, 
to  be  connected  with  the  medical  school.  A  committee  of  prominent 
dentists  of  the  .dty  have  presented  plans  to  the  Medical  Faculty  which 
have  been  approved. 

The  school  of  dentistry  will  be  closely  associated  with  the  medical 
school  and  the  admission  requirements  will  be  the  same  as  the  medical. 
The  course  will  be  four  years,  the  first  two  years  the  same  as  those  in 
medidne,  thus  giving  the  dental  student  a  thorough  knowledge  of  the 
fimdamental  sdences  necessary  to  the  practice  of  a  spedalty  of  medidne. 
At  the  end  of  the  second  year  the  dental  student  will  give  all  his  time  to 
the  study  of  dental  subjects,  namely,  operative  dentistry,  prosthetic 
dentistry,  oral  surgery  and  oral  pathology,  orthodontia,  etc.,  and  the  more 
technical  part  of  the  work  required  for  the  well  trained  dental  surgeon. 
This  new  school  will  be  the  first  university  dental  school  in  New  York 
City  and  the  second  in  the  State.  It  will  give  the  first  four  year  course 
of  dentistry  ever  given  in  the  Empire  State. 


DR.  WILLIAMS  NEEDS   TEETH 

In  the  course  of  our  studies  in  tooth  form,  we  have  need  of  a  good 
many  natural  anterior  teeth,  not  decayed  to  an  extent  which  destroys  the 
form. 

If  you  have  any  such  and  wish  to  aid  Dr.  Williams  in  his  work  for  the 
benefit  of  the  whole  profession,  will  you  not  please  forward  them  to  Dr. 
J.  Leon  Williams,  in  my  care?  I  will  gladly  pay  the  express  charges  or 
refund  any  postage  you  may  paiy. 

The  importance  of  this  request  is  seen  when  it  is  remembered  that  it 
was  such  a  contribution  of  teeth  from  Dr.  Friesell,  that  enabled  Dr. 
Williams  to  put  his  discovery  of  typal  forms  into  definite  terms. 

George  Wood  Clapp. 


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(TINE^BVILDING 


The  only  business  which  is  good  busi- 
ness is  that  business  which  tends  to  build 
the  man  while  the  man  is  building  the 
business. — ''Neptune'' — Nebr,  Dent,  Jour, 


WHAT  SHALL  WE  CHARGE  FOR  PLATES? 

By  W.  J.  HoLROYD,  D.D.S.,  Pittsburgh,  Pa. 

Whoever  shows  us  what  it  costs  us  to  render  professional  service, 
benefits  each  of  us  who  is  not  doing  himself  justice  and  each  patient  who 
is  not  receiving  justice  in  the  form  of  adequate  service. 

A  long  study  of  this  subject  of  patients,  service  and  fees,  has  con- 
vinced me  that  when  dentists  are  sufficiently  paid  to  permit  them  to  do 
their  best  for  each  p>atient,  we  shall  see  such  a  wave  of  technical  advance- 
ment as  no  generation  of  dentists  has  yet  witnessed.  Here  and  there  a 
man  is  divining  his  opportunities  and  rising  to  his  possibilities.  Ac- 
quaintance with  several  such  cases  shows  that  the  p>atients  are  even 
more  delighted  with  the  results  of  such  a  course  than  are  the  dentists 
with  the  increased  income. 

Dr.  Holroyd's  figures  deal  in  a  practical  way  with  one  phase  of  service 
which  greatly  needs  such  treatment.  Answer  him  if  you  wish,  but  first 
time  yourself  on  work  well  done,  that  you  may  know  whereof  you  speak. 
— Editor. 

FOREWORD 

From  a  high  authority — President  Pritchett,  of  the  Carnegie  Founda- 
tion— we  leam  that  the  medical  profession  scarcely  pays  now,  and  tends 
to  pay  even  less.  "It  is  becoming  more  and  more  a  profession  to  which 
men  give  themselves  from  ideals  of  public  service,  recognizing  that  the 
average  practitioner  is  to  obtain  little  more  than  a  comfortable  living, 
and  in  many  cases  not  even  that.  The  parent  who  seeks  for  his  son  a 
remunerative  occupation  should  look  elsewhere." 

Everybody  knows  that  teaching  does  not  pay  and  preaching  pays 
still  less,  while  literature — if  you  measure  the  tcftal  bulk  of  the  time 
expended  against  the  gross  receipts — represents  a  positive  deficit.  There 
remains  the  law,  in  which  a  sufficiently  agile  youth  may  now  and  then 
overtake  a  fortune,  but  the  grand  prizes  are  few  and  the  average  income 
is  about  equal  to  that  of  a  good  carpenter. 

Dentistry  may  be  classed  with  the  above. 

Thus,  of  the  old  professions,  none  pay.  A  diligent  and  skilful  man 
may  make  a  comfortable  living  and  keep  up  the  premiums  on  his  life 
insurance.    Why  then  do  practitioners  of  the  learned  profession  persist 


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WHAT  SHALL  WE  CHARGE  FOR  PLATES  227 

in  trying  to  make  them  pay?    How  much  they  might  simplify  pro- 
fessional life  by  going  in  frankly  for  '* ideals  of  public  service"  with  a 
reasonable  pension!    Probably  there  are  more  furtive  Socialists  among 
professional  men  than  professed  ones  among  workingmen. 
So  much  for  Prof.  Pritchett. 

From  the  above  it  would  seem  that  the  men  in  the  professions  have 
not  a  very  desirable  financial  outlook  for  the  future.  It  does  not  be- 
hoove dentists  to  stay  dormant,  but  to  agitate  a  movement  wherein  such 
conditions  may  be  remedied.  We  cannot  pretend  to  do  it  in  the  other 
professions,  but  we  can  help  our  own  to  a  very  material  extent — treat 
it  as  merchants  treat  bad  conditions  in  their  business — by  analysis,  con- 
trast, and  comparison.  We  can  get  at  the  cause  and  then  outline  a 
policy  that  will  bring  order  out  of  chaos. 

The  habit  of  "Studying  the  Cost  of  Conducting  a  Business,"  is  going 
on  all  over  the  country.  It  is  only  right  that  we  dentists  should  fall  in 
line  and  study  our  own  profession,  with  a  view  of  securing  for  ourselves 
proper  remuneration,  because  if  we  don't  we  shall  go  to  the  wall.  A  man 
is  more  sure  of  himself,  and  has  more  confidence  and  poise  in  quoting 
prices,  if  he  knows  what  he  is  talking  about.  A  man  who  has  '*  timed'' 
himself  on  different  operations  knows  why  he  is  asking  a  higher  price  for 
work  than  the  dentist  who  charges  a  certain  price  for  no  other  reason  than 
that  it  is  the  custom.  Considering  that  a  dentist  of  lo  years*  standing 
is  only  averaging  $1,250,  nel  income  per  year  and  the  cost  of  living  still 
going  higher,  a  thinking  dentist  realizes  that  something  must  be  done,  in 
order  to  hold  his  footing  among  men  of  the  same  standing  in  other  voca- 
tions. 

There  has  been  an  awakening  all  over  the  country  among  the  dentists, 
in  regard  to  the  right  minimum  prices  of  different  pieces  of  work  manu- 
factured by  the  dentist  and  an  earnest  demand  for  authentic  data  to 
work  from  has  been  vigorously  solicited. 

Dentists  want  to  know.  There  are  now  some  live  men  in  the  pro- 
fession and  they  are  no  longer  content  with  just  making  no  better  living 
than  a  carpenter,  a  bricklayer,  or  a  draughtsman.  Considering  that  they 
have  spent  so  much  money  and  time  for  their  education  and  have  more 
responsibility,  being  dentist,  educator,  salesman,  and  bookkeeper,  they 
are  justified  in  wanting  more  remuneration  than  the  artisan  whose 
responsibility  is  shouldered  by  his  employer. 

Dentists  have  a  right  to  know  what  fees  they  are  entitled  to  and  until 
they  do,  dentistry  will  not  stand  where  it  belongs,  for  in  order  to  attract 
the  best  brains  to  it,  it  must  also  be  possible  for  a  man  to  make  something 
more  than  a  living. 


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228  TH£  DENTAL  DIGEST 

Only  I  per  cent,  of  the  men  in  our  profession  to-day  are  highly 
schooled.  Why  should  a  business  man  who  has  gotten  along  to  where 
he  can  afford  to  send  his  boy  to  common  school,  high  school,  preparatory 
school  and  then  college,  let  that  same  boy  after  all  that  education,  take 
up  a  profession  that  yields  approximately  only  $125  a  month  after  being 
10  years  in  business.  You  would  not  let  one  of  your  own  boys  do  it. 
You  would  say  yourself,  *'No  son,  after  all  that  schooling,  you  must  take 
up  something  that  will  yield  better  returns. "  Thus  we  have  an  instance  of 
a  highly  cultivated  brain  being  lost  to  the  profession.  In  a  Yale  graduat- 
ing class  of  300  or  more — 160  proposed  to  be  lawyers;  the  rest  were 
divided  between  medicine,  architecture,  engineers,  etc.;  not  one  of  the 
whole  class  said  he  would  take  up  dentistry.  True,  some  dentists  have 
made  signal  financial  success  without  business  education,  but  they 
did  it  in  spite  of  non-education,  not  because  of  it.  How  infinitely  better 
might  they  have  been  had  they  had  that  education.  We  all  regret  it. 
Therefore  we  must  get  better  remuneration  for  our  work,  if  we  would  get 
this  class  of  man  into  the  profession. 

Times  are  changing  more  rapidly  now  than  ten  years  ago  and  dentistry 
is  also  changing  very  rapidly.  The  average  dentist  cannot  keep  up  with 
it.  It  costs  every  dentist  more  to-day  to  conduGt  business  than  10 
years  ago  and  still  his  prices  for  work  remain  the  same,  and  he  has 
to  do  more  work  to  make  it  up.  Right  there  he  is  going  back — out  of 
date.    Therefore,  we  are  going  to  show  him  how  he  may  help  himself. 

Remember  these  words  throughout  all  of  this  article — Contrast  and 
Comparison — everything  is  governed  by  it.  If  a  man  were  on  an  island 
and  he  had  no  one  to  compare  himself  with,  he  would  not  know  whether 
he  were  stout  or  thin,  long  or  short,  strong  or  weak,  fast  or  slow.  We 
don't  know  whether  a  building  is  tall  until  we  compare  it  with  another, 
or  whether  our  salary  is  large  or  small  unless  compared  with  someone 
else,  and  so  on  down  the  list.  The  world  is  governed  by  contrast  and 
comparison  a  thousand  times  a  day.  They  are  all  about  us  and  men  use 
them  constantly  in  the  day's  work — that  is,  all  men  but  dentists.  It 
does  not  seem  to  have  entered  their  craniums  as  yet. 

We  are  going  to  contrast  the  wearing  value  and  prices  of  our  work, 
with  the  value  and  price  of  other  goods  tendered  by  merchants,  weighing 
service  for  service.     Contrast  the  following: 

If  a  patient  pays  $30  for  a  suit  and  it  wears  for  one  season,  why  should 
he  expect  your  $30  piece  of  work  to  last  10  years. 

If  you  buy  two  pairs  of  shoes  at  $5  a  pair  and  they  last  one  year,  why 
can't  you  ask  $10  for  a  good  gold  crown,  lasting  10  years? 

If  a  workingman  pays  50  cents  for  a  theatre  ticket,  for  one  night,  he 
can  afford  to  pay  $3  for  a  good  amalgam  filling,  lasting  10  years. 


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WHAT  SHALL  WE  CHARGE  FOR  PLATES 


229 


If  a  lady  in  ordinary  circumstances  can  aflford  to  pay  $75  for  a  medium 
class  set  of  furs,  which  she  only  wears  a  few  hours  per  week  for  four 
months  a  year,  she  can  afford  to  pay  $60  for  good,  well  articulated,  care- 
fully made  dentures,  which  she  wears  all  the  time,  and  on  which  she 
will  eat  10,000  meals  in  10  years. 

Contrast  and  Comparison — ^ponder  it.    Open  your  eyes. 

According  to  Dun's  report,  the  expense  of  living  has  gone  up  50 
per  cent,  in  the  last  10  years.  This  includes  the  living  of  dentists,  also. 
That  is,  your  $150  only  goes  as  far  now  as  $100  did  10  years  ago,  and  if 
your  prices  in  dentistry  remain  the  same  you  have  to  work  half  as  hard 
again  to  accomplish  the  same  results,  in  a  given  time  as  you  did  10  years 
ago.    Think  about  this. 

Even  if  you  had  raised  your  prices  50  per  cent,  that  $5  crown  to  $7.50, 
$15  plates  to  $22.50,  50  cent  extractions  to  75  cents,  and  so  on,  you  would 
only  be  in  the  same  position  as  you  were  10  years  ago,  and  not  advancing 
any.  As  it  is  you  charge  the  same  prices  and  have  to  work  half  as  hard 
again  and  then  you  just  stay  in  the  same  place.  No  gain  as  your  reward 
In  fact  you  are  going  back,  because  you  cannot  save  anything  and  are 
getting  older. 

Let  me  give  an  instance  in  our  own  profession  by  comparing  some  of 
the  expenses  of  two  offices  of  10  years  ago  and  to-day. 


1902 

191 2 

Rents 33  %  more 

Telephone       .... 

None 

Telephone     .     . 

$  so  per  yr. 

Office  girl        .... 

$    S  per  wk. 

Office  girl     .     . 

8  per  wk. 

Foot  engine    .... 

36 

Electric  engine 

150 

Foot  lathe. 

16 

Electric  lathe     . 

35 

Brass  cuspidor           .     . 

3.50 

Fountain  cuspidor 

40 

Dental  chair  .... 

125 

Dental  chair 

i8s 

Cabinets 

60 

Cabinets       .     . 

150 

Foot  Bellows  .... 

5 

Compressor 

12 

Porcelain  furnace 

None 

Porcelain  Furnace 

100 

Switchboard          .      .      . 

None 

Switchboard  with  appliances    250 

Typewriter      .... 

None 

Typewriter    .      . 

100 

And  so  on  ad  infinitum.  The  list  could  be  made  much  longer,  but  the 
above  is  enough  for  example.  In  the  office  described  in  the  first  column, 
such  equipment  was  not  looked  upon  askance  10  years  ago,  but  woe 
betide  the  up-to-date  man  of  to-day  who  has  not  the  articles  in  the  second 
colunm.  He  cannot  claim  to  be  up-to-date  if  he  hasn't  them,  as  they 
are  now  necessities.  But  few  men  have  them,  because  most  men  can't 
afford  them.  The  prices  gotten  in  their  practices  do  not  justify  the 
outlay.  They  haven't  any  money  left.  Some  dentists  are  up-to-date 
enough  to  go  to  conventions,  where  the  Dental  Manufacturers  have  their 
exhibits  and  look  with  envy  upon  the  new  appliances  designed  by  experts 
in  the  profession.  They  would  like  to  bring  their  offices  up  to  date,  yet 
they  keep  on  plodding  at  their  work  in  the  old  way,  never  dreaming  that 


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230  THB  DENTAL  DIGEST 

they  can  alter  their  patients'  viewpoint  just  as  other  merchants  have 
altered  their  patrons'  viewpoint. 

Remember  the  merchants  have  spent  thousands  of  dollars  educating 
people  to  imderstand,  appreciate  and  follow  the  styles.  There  used  to  be 
summer  and  winter  clothes — we  all  remember  them.  Now,  there  are 
four  seasons  and  they  have  even  stopped  the  ladies  from  interchanging 
their  dresses — they  have  now  to  dress  in  ''tones."  This  "education** 
includes  dentists'  wives. 

FOR  DENTISTS 

Financial  success  is  all  a  matter  of  educating  the  patient  and  studying 
costs,  and  raising  prices  so  you  can  buy  these  new  labor  saving  appliances 
and  become  up  to  date.  Remember  that  the  manufacturer  is  the  man 
who  places  the  price  on  everything  in  your  office.  You  were  told  the  price 
and  you  paid  or  left  it.  But  the  majority  of  dentists  allow  their  patients 
to  quote  the  price  of  work.  We  are  not  salesmen,  just  mere  order  takers. 
Patients  say  the  price  is  too  much  and  we  cut  the  price  to  suit  their 
pocketbooks — in  the  face  of  the  fact  that  they  are  paying  other  manu- 
facturers $1  where  we  get  25  cents. 

Now  it  has  been  proven  that  to  maintain  an  office  as  above  (2nd  col- 
umn) and  constantly  keep  in  touch  with  new  improvements,  takes  50 
cents  on  the  dollar  of  gross  receipts  at  present  average  prices,  before  the 
dentist  has  anything  left  for  himself.  To  make  a  larger  percentage  on 
the  dollar,  he  will  have  to  charge  more  all  along  the  line  for  his  work.  To 
do  this  intelligently  he  will  have  to  go  to  the  trouble  of  **  timing"  himself 
during  different  operations.  If  he  does  that,  he  will  not  need  any  one 
to  beg  him  to  change  his  viewpoint. 

All  business  men  and  manufacturers  put  a  price  on  their  product, 
based  on  quality  of  labor  and  the  ti?ne  it  takes,  and  no  trouble  is  too  great 
that  enables  them  to  get  results.  They  sit  up  nights  and  have  meetings 
and  call  in  cost  experts  to  help  them.  This  brings  us  to  the  analysis 
of  the  heading  of  this  paper. 

What  should  we  conscientiously  charge  for  plates — what  should  be 
the  minimum  price? 

Some  time  ago,  we  sent  broadcast  to  35,000  dentists,  through  the 
Courtesy  of  Oral  Hygeine^  a  time  chart  for  plates,  asking  dentists  to 
fill  in  the  time  required  for  the  different  steps  and  return  to  us  for  com- 
pilation and  averaging.  We  have  received  a  great  deal  of  help  and  this 
article  will  give  you  the  results.  Although  it  emphatically  demonstrates 
that  the  dentists  need  to  be  taught  how  to  do  things  for  their  own  good, 
some  men  must  have  thought  the  timing  was  intended  to  be  a  race — to 
see  how  quickly  they  could  do  a  certain  specified  piece  of  work — ^and  some 


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WHAT  SHALL  WE  CHARGE  FOR  PLATES  231 

again  have  been  very  conservative  and  have  gotten  together  a  very  fair 
average  of  "times.*' 

The  timing  of  operations  means  an  average  of  many  times  (say  20), 
and  when  a  man  writes  that  he  can  paint  an  impression,  pour  model  and 
mix  his  plaster  right,  so  that  it  has  no  bubbles  and  every  particle  of 
plaster  comes  in  contact  with  water  in  two  minutes  and  then  separate 
and  build  up  trial  base  plate,  according  to  the  latest  accepted  standard, 
in  three  minutes,  and  at  this  rate  make  a  whole  upper  denture  in  i  hour, 
47  minutes,  then  his  records  are  not  to  be  put  down  to  average  with 
other  conservative  men,  who  do  the  work  more  thoroughly.  Such 
timing  is  not  correct  and  it  is  a  reflection  on  the  compilers'  intelligence  to 
quote  his  figures  in  averaging. 

The  average  time  from  more  than  150  reliable  statistics  results  as 
follows: 

CHAIR   TIME 

Time  consumed  in  making  contract  for  plate: 

Examination  and  consultation 30  minutes 

Taking  impression 15        " 

Taking  bite 20        " 

Trial  plate  fitted 30 

Fitting  denture  in  mouth 15        " 

There  shows  an  average  of  4  trips  for  plate  to  be  adjusted,  sometimes  to  be 
scraped  and  troubles  at  other  times  imaginary,  but  consuming  time  about 

20  minutes  each  visit 80        ** 

LABORATORY   TIME 

Painting  impression  and  pouring  model 12  minutes 

Separating  and  making  trial  base  plate 20  " 

Mounting  on  articulator 10  " 

Selecting  teeth 15  " 

Articulating 46  " 

Final  waxing 25  " 

Investing 20  " 

Packing,  putting  in  and  taking  from  vulcanizer.     (Does  not  include  time  for 

actual  vulcanizing)         90  " 

Scraping  and  polishing          60  " 

60)488 

8  hrs.  8  min. 
Percentage  of  makeovers  25  per  cent 2  " 

10" 

These  times  are  compiled  from  quite  a  number  of  dentists  and  prove 
that  work  can  be  averaged  to  such  an  extent  that  a  basis  of  price  can  be 
arrived  at.  Remember,  this  sending  out  to  35,000  dentists  for  data  was 
never  done  before,  and  proved  quite  a  task  and  if  any  skeptics  differ  with 
any  of  the  above  statistics,  I  shall  be  glad  to  be  corrected  if  they  will  go 
to  the  same  amount  of  trouble. 


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232  THB  DENTAL  DIGEST 

Now  if  it  takes  50  cents  on  the  dollar  to  conduct  an  up-to-date  office 
and  if  you  only  charge  $20  for  a  plate  and  it  takes  you  10  hours  to  make 
It,  you  can  readily  see  that  it  costs  you  $10  to  make  that  plate,  counting 
material  and  overhead  expenses  (which  lots  of  dentists  never  think  about), 
leaving  practically  $1  per  hour  for  yourself,  which  sum  a  jobbing  plumber 
demands  when  he  comes  to  open  your  sink.  A  tile  setter  gets  62^  cents 
per  hour.  After  spending  your  money  and  3  years  for  education  and  tak- 
ing all  the  responsibilities  of  business  worries  and  building  up  your  prac- 
tice, ask  yourself  if  you  are  not  worth  more  than  $1  per  hour  net.  Some 
of  the  mechanics'  wages  are  only  a  few  cents  less  per  hour  and  they  have 
no  overhead  responsibility. 

You  might  say  the  laboratory  does  a  lot  of  it  and  it  is  really  not  your 
time.  I  can  get  a  plate  made  for  $3  and  charge  $15,  that  is  $12  profit. 
This  way  of  figuring  is  not  right.  Too  many  dentists  figure  that  way. 
Overhead  charges  and  running  expenses  must  be  put  against  the  first 
price,  and  considering  that  the  dentist  is  made  responsible  for  any  work 
that  does  not  fit  and  any  makeovers  must  come  out  of  his  own  pocket, 
he  must  charge  and  receive  the  profit  as  if  he  had  made  the  whole  plate 
himself.  If  the  dentist  has  to  stand  the  brunt  of  mistakes  of  other 
people  whom  he  employs,  he  at  least  is  entitled  to  the  profits  of  their 
labor.  It  is  so  all  over  the  conunercial  world.  A  dentist  of  10  years' 
practice  should  be  earning  $6  per  hour  gross — earning  $3  net  per  hour. 

Another  point  of  vital  importance.  It  has  been  conceded,  after  a 
lengthy  canvass  of  the  foremost  men  of  the  profession  and  accountants 
and  cost  experts  on  the  side,  that  highly  specialized  laboratory  work 
should  command  as  much  pay  as  work  at  the  chair. 

This  special  problem  of  whether  the  laboratory  charges  should  be 
charged  at  the  same  price  as  chair  time  was  put  up  to  the  representative 
of  one  of  the  largest  cost  expert  firms  of  Pittsburgh,  who  handles  the 
business  of  large  corporations,  and  his  decision,  after  giving  the  point 
much  thought,  was  decidedly  in  the  affirmative.  Large  law  firms  do  it, 
the  work  of  subordinates'  work  is  charged  the  head  of  the  firm's  prices,  and 
the  head  of  the  firm  takes  the  responsibihty.  The  principle  is  the  same 
in  our  case.  Other  instances  can  be  given  in  architects'  and  engineers' 
offices,  etc.,  which  proves  enough  precedent,  and  considering  that  these 
cost  experts  have  studied  such  points  as  these  and  that  these  decisions 
are  accepted  by  banks  and  the  commercial  world  in  general,  we  are  only 
showing  our  ignorance  by  doing  otherwise.  Such  a  course  will  only 
prove  our  undoing. 

It  has  also  been  brought  out  in  another  paper  that  the  productive 
time  in  an  office  for  one  year  is  only  /  fioo  hours ;  the  dentist  may  be  in  his 
office  2,500  hours  but  the  losses,  including  time  exceeding  that  con- 


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WHAT  SHALL  WE  CHARGE  FOR  PLATES  233 

tracted  for,  makeovers,  times  for  consultations  and  charity  work — 
cut  down  the  actual  producing  hours  to  an  alarming  extent.  One  thou- 
sand hours  have  to  stand  the  brunt  of  the  charges. 

Therefore,  the  foregoing  brings  us  to  the  crucial  point  that  lo  hours' 
work  on  a  single  vulcanite  plate  at  $6  per  hour  is  $60,  which  is  the  mini- 
mum price  that  ought  to  be  charged,  gold  plates  in  proportion,  con- 
sidering the  knowledge  which  is  put  into  a  properly  fitting  denture. 
This  leaves  $30  for  yourself. 

This  price,  gentlemen,  is  what  single  rubber  dentures  will  bring  when 
the  dentists  wake  up  to  the  cost  of  conducting  their  practices  and  a 
knowledge  of  what  is  their  due.  There  are  more  dentists  who  have 
realized  these  facts  and  are  charging  these  prices  than  you  would  imagine, 
and  at  that,  the  patient  is  not  paying  one  whit  more  than  he  pays  for 
other  things,  considering  value  dollar  for  dollar.  The  poor  man  who 
scrapes  his  money  together  and  pays  $250  for  a  piano  pays  the  salesman 
$125  profit.  If  it  takes  the  salesman  one  hour  to  sell  him  that  piano  that 
workingman  pays  him  $125  for  one  hour's  work  and  that  salesman  does 
not  shed  any  tears  over  it  either.  The  poorest  working  people  can  and 
do  afford  and  pay  the  various  dealers  a  bigger  rate  of  profit  for  various 
articles  than  they  do  the  dentist,  considering  the  length  of  service  ren- 
dered. It  is  estimated  that  the  dentist  only  asks  25  cents  on  the  dollar 
compared  with  other  men  in  other  business.  Yes  and  even  less.  Instead ' 
of  being  called  D.D.S.  we  ought  to  be  called  D.P.P. — ^Department  of 
Public  Philanthropy. 

It  is  not  just,  considering  the  knowledge  required,  that  a  dentist 
should  receive  only  the  pay  of  a  good  workingman  or  artisan.  This 
fact  explains,  as  a  Dean  of  a  college  once  said,  why  after  5  years  a  good 
many  graduated  dentists  drop  out  of  practice  into  other  callings.  A 
good  many  dentists  in  the  farming  districts,  who  complain  of  cheap 
prices,  claim  their  class  of  patients  could  not  pay  these  prices,  but  do 
you  find  the  merchants  of  the  city  reducing  prices  of  farmers'  neces- 
sities on  that  account?  The  farmers  pay  the  merchant  the  same  price 
and  ratio  ot  profit  as  does  the  workingman  in  the  city.  Every  other  line 
of  business  from  pins  to  automobiles  is  now  controlled  by  interests  that 
have  educated  (a  little  at  a  time)  the  masses  (including  dentists)  to  pay 
considerably  more  than  was  paid  10  years  ago.  That  is  an  accepted  fact 
but  the  prices  of  dental  work  have  not  changed  to  an  appreciable  extent 
in  the  last  15  years  . 

It  bespeaks  a  lack  of  business  acumen  and  a  laxity  in  keeping  up  with 
the  times  on  the  dentists'  part.  Dentists  may  protest  and  say  proper 
fees  can't  be  gotten,  but  they  are  being  gotten  by  the  ones  that  are 
"waking  up,"  who  are  determined  to  secure  a  competence  in  their  old  age. 


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234  THB  DENTAL  DIGEST 

A  word  about  this  competence.  A  competence  is  at  least  $30,000, 
which  yields,  at  4  per  cent.,  $1,200  yearly,  or  $100  a  month.  Ask  your- 
self, have  you  got  it  or  are  you  saving  it?  If  you  are  saving  anything 
at  all  it  is  not  from  making  plates,  and  it  behooves  you  to  study  which 
department  of  practice  you  are  losing  money  in,  and  plates  is  one  of  them. 

The  remedy  is — start  to-day.  When  the  next  patient  for  a  plate 
comes  to  you,  do  not  give  him  any  limit,  say  (to  start  the  propaganda) 
that  he  can  have  any  price  up  to  $60,  and  then  he  will  naturally  want  to 
know  the  difference,  then  show  him  the  anatomical  articulator,  the  new 
rubbers  and  the  new  teeth  and  it's  up  to  you  to  work  the  salesmanship 
stunt  just  as  it  is  worked  on  you.  Don't  keep  on  quoting  $10,  $12,  and 
$15  eternally.  Sell  service  and  you  will  be  surprised  within  six  months 
what  a  material  change  you  can  bring  about  among  the  very  people  you 
are  now  working  for.  Start  to-day  and  then  shortly  you  will  be  able  to 
fit  up  an  oflSice  such  as  you  have  dreamed  of — and  keep  things  going  along 
these  lines. 


PROOF  OF  MALPRACTICE  IN  DENTISTRY 

In  recently  affirming  judgment,  a  Chicago  dental  company  in  favor  of  a 
patient  for  $1,000,  as  recovery  for  injuries  claimed  to  have  been  sustained 
by  the  latter  by  reason  of  negligent  performance  of  dental  work  done  for 
her  by  defendant's  employee,  the  Illinois  Appellate  Court  decided  that 
malpractice  was  sufficiently  established  by  proof  that  the  employee 
negligently  bored  through  the  roots  of  four  of  plaintiflF's  teeth  into  the 
alveolar  process  or  bony  tissues  of  the  jaw,  thereby  causing  a  painful 
condition,  which  required  long  treatment  and  rendered  impracticable 
the  placing  of  a  permanent  dental  bridge.  Incidentally,  the  Appellate 
Court  held  that  it  was  not  improper  to  permit  an  expert  witness  to  testify 
in  plaintiff's  favor  as  to  the  condition  of  the  bore  in  plaintiff's  teeth  the 
year  following  the  treatment  by  defendant's  employee,  without  requiring 
plaintiff  to  first  show  that  no  one  else  had  treated  the  teeth  in  the  mean- 
time, since  it  was  open  to  defendant  to  show  that  the  condition  of  plain- 
tiff's teeth  was  aggravated  by  anything  for  which  defendant  was  not  re- 
sponsible, if  there  was  any  such  aggravation. 

A.  L.  H.  Street, 

St.  Paul,  Minn. 


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ANSWER  TO  A  REQUEST  FOR  ADVICE  235 


ANSWER  TO  A  REQUEST  FOR  ADVICE 

I  am  opposed  to  any  advertising  which  makes  any  mention  of  the 
dentist's  personal  skill,  special  methods,  etc. 

I  don't  believe  the  restrictive  adjectives  "fraudulent"  or  "mislead- 
ing" as  applied  to  statements  will  have  any  practical  value.  It  is  not 
anyone's  business,  in  particular,  to  stop  such  statements,  and  the  door 
will  be  just  as  wide  open  as  ever. 

If  this  society  wants  to  accomplish  something  let  it  change  the  word- 
ing to  something  like  the  following:  "Any  member  making  any  refer- 
ence to  his  own  personal  skill,  to  special  methods,  etc.,  or  advertising  ser- 
vice at  lower  fees  than  he  expects  to  receive  for  a  fair  grade  of  service,  shall 
be  brought  before  such  and  such  a  conmiittee  and  if  the  charge  is  sustained 
shall  be  suspended  for  90  days  and  for  a  third  offense,  suspended  per- 
manently." 

In  other  words  what  is  needed  is  not  publicity  for  the  dentist's  special 
qualifications,  but  for  dentistry  as  a  means  of  good  service. — Editor. 

Editor  Dental  Digest: 

Will  you  kindly  allow  me  to  answer  **A  Request  for  Advice"  by 
** Massachusetts''  in  February  Digest.  His  whole  list  of  questions  sum- 
marized, is  that  he  believes  in  honorable  publicity,  and  wants  to  know 
why  he  can't  use  it,  and  retain  the  respect  of  other  dentists. 

During  my  32  years  as  a  dentist  and  reader  of  dental  journals,  this 
same  proposition  has  been  presented  in  various  forms,  and  nothing 
practical  has  ever  come  of  it. 

It  is  certainly  time  for  a  clear  answer  to  be  given,  so  that  every  den- 
tist may  understand. 

The  Code  of  Ethics,  Art.  2,  Sec.  2,  says:  "It  is  unprofessional  to 
resort  to  public  advertisements,"  etc. 

There  is  your  answer,  and  that  certainly  has  been  approved  by  every 
dental  society  in  this  country  by  the  adoption  of  their  code  of  ethics. 
Moreover,  it  will  never  be  changed  by  societies  who  have  adopted  it,  for 
good  and  sufficient  reasons  of  their  own,  and  any  discussion  with  that 
end  in  view  is  as  useless  now  as  it  has  been  in  the  past.  You  may  think 
this  an  unreasonable  assertion,  but  let  us  look  at  the  facts.  Let  us  look 
at  dental  organization  as  it  exists  to-day. 

Most  all  of  the  State  Dental  Societies  belong  to  the  National  organi- 
ation,  and  aU  have  practicaUy  the  same  code  of  ethics.  We  will  look 
into  the  organization  of  one  state  dental  society  knowing  that  it  is  but 
similar  to  all  the  other  states;  the  knowledge  of  one  will  be  knowledge  for 
all. 

I  have  before  me  the  by-laws  of  the  Wisconsin  State  Dental  Society. 
This  society  is  incorporated,  and  its  executive  council  ''has  absolute 
control  of  the  entire  business*'  of  the  society,  and  may  sit  with  closed 


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236  THE  DENTAL  DIGEST 

doors.  This  council  consists  of  twelve  active  members,  of  whom  the 
president,  secretary  and  treasurer  of  the  society  shall  constitute  a  part 
and  these  shall  be  the  officers  of  the  council.  Three  members  of  the  coun- 
cil are  elected  each  year  and  serve  for  there  years.  The  president  pre- 
sides at  all  meetings  of  the  coimcil  and  can  call  special  meetings  at  the 
written  request  of  three  of  its  members.  Seven  members  constitute  a 
quorum  and  the  majority  rules.  A  majority  of  the  Executive  Coimcil 
of  twelve  members  is  seven,  a  majority  of  a  quorum  of  seven  members  is 
four.  Thus  from  four  to  seven  members  of  the  council  constitute  the 
determining  power  concerning  absolutely  all  the  business  of  the  society. 

As  to  the  powers  of  the  Executive  Council  I  wiQ  quote  by-law  Art.  2, 
Sec.  I. 

**The  Executive  Council  shall  have  absolute  control  of  the  entire 
business  of  the  society  and  may  sit  with  closed  doors.  Any  member  of 
the  Society  desiring  to  bring  any  matter  of  business  before  the  council 
may  do  so  in  writing  and  appear  in  behalf  of  such  measure,  by  consent 
of  the  Executive  Council.'' 

The  Executive  Council  is  further  empowered  to  elect  all  standing 
committees,  which  are,  Dental  Science  and  Literature,  Dental  Art  and 
Invention,  Publication  Committee,  Program  Committee,  Clinic  Com- 
mittee, Board  of  Censors,  Infraction  of  Code  of  Ethics,  Local  Committee 
of  Arrangements;  also  select  the  place  of  annual  meeting.  In  case  of  the 
absence  of  the  president  and  vice-presidents,  the  council  shall  fill  their 
places.  The  council  shall  pass  on  the  expenditure  of  all  moneys  of  the 
society.  It  may  authorize  certain  officers  or  committees  to  expend 
money  for  specific  purposes.  They  shall  appoint  annuaUy  an  auditing 
committee  from  their  own  number  to  examine  the  books  of  the  secretary 
and  treasurer. 

While  there  are  still  other  powers  granted  the  council,  the  above  is 
sufficient  to  show  that  the  membership  has  empowered  the  council  with 
absolute  authority  in  all  matters  of  business  that  concerns  the  society. 

The  ordinary  member  may  vote  once  a  year  for  the  society's  officers. 

May  be  appointed  by  the  Council  on  some  conmiittee. 

May  attend  the  annual  meeting. 

Shall  pay  dues.  This  is  the  extent  of  his  society  organization  privilege 
and  usefulness.  So  here  is  the  present  plan  of  Dental  Society  organiza- 
tion.   What  do  you  think  of  it? 

Now  if  the  code  of  ethics  is  to  be  changed  by  dental  societies  as  now 
organized,  by  granting  and  defining  honorable  advertising  from  the 
twelve  dentists  governing  the  state  society,  what  are  the  prospects?  It 
has  been  a  long  road  to  their  present  position  and  they  are  satisfied.  The 
proposed  change  would  endanger  the  present  line-up  of  prestige  and 


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ANSWER  TO  A  REQUEST  FOR  ADVICE  237 

personally  it  could  not  appeal  to  them.  Every  society  member  has 
signed  the  Constitution  and  By-laws,  as  well  as  the  Code  of  Ethics,  and 
no  council  dentist  could  champion  such  change  without  censure  and  loss 
of  prestige  among  his  fellows.  Unquestionably  the  road  is  closed  for 
recognition  of  honorable  advertising  by  the  self-styled  ethical  societies. 

The  power  of  the  executive  council  is  supreme.  The  twelve  dentists 
direct  all  things  professional  in  the  state.  They  say  the  dental  profession 
will  not  endorse  this  or  that — they  know — ^because  they  are  the  profession 
— at  least  the  controUing  force  invested  with  authorized  power. 

Those  who  believe  in  honorable  publicity  in  dentistry  should  remember 
that  it  is  utterly  useless  to  expect  dental  societies,  as  now  organized,  to 
recognize  it,  and  there  remains  just  one  thing  to  do,  and  that  is  to  organize 
dental  societies  in  all  the  states  that  do  recognize  honorable  pubUcity  in 
dentistry,  not  only  as  professional,  but  ethical  and  reputable  as  well. 

Until  this  is  done,  any  dentist  who  uses  honorable  pubUcity  of  any 
kind,  will  be  looked  upon  by  the  profession  as  improfessional,  unethical 
and  disreputable,  the  same  as  they  have  been  during  the  past  50  years. 

Dentists  in  Wisconsin  last  year  organized  and  incorporated  the 
Modem  Ethical  Dental  Society  of  Wisconsin.  They  adopted  the  same 
code  of  ethics  as  that  of  the  other  society,  except  in  regard  to  that  pertain- 
ing to  advertising;  and  instead  have  adopted  the  following  as  Sec.  2: 

**It  shall  be  unprofessional  for  any  dentist  to  circulate  or  advertise 
fraudulent  or  misleading  statements  as  to  the  skiU  of  the  operator,  the 
quality  of  materials,  drugs  or  medicines  used  or  methods  practised." 

You  will  see  from  this  that  this  Society  regards  all  other  publicity  as 
proper. 

A  similar  society  has  been  organized  in  Michigan  and  Indiana  and 
dentists  in  several  other  states  are  now  considering  such  an  organization. 
We  would  suggest  to  all  those  who  believe  in  honorable  pubUcity  to  find 
other  dentists  in  their  state  who  hold  the  same  views,  and  then  organize 
a  Modem  Ethical  Dental  Society  in  their  state.  They  then  wiU  be  in  a 
position,  unhampered  by  a  tyrannical  code,  to  conduct  their  dental  busi- 
ness in  accordance  with  the  dictates  of  their  own  conscience. 

I  wiU  be  glad  to  help  in  any  way  I  can  to  encourage  such  organizations 
for  it  is  our  hope  that  the  time  is  not  far  distant  when  there  may  be  or- 
ganized a  National  Modem  Ethical  Dental  Society.  B.  A.  J. 


The  weak  worry  so  much  about  the  future  than  they  never  get  a 
foothold  in  the  present.  One  cannot  do  efficient  work  if  his  mind  is 
filled  with  fear  pictures  of  what  may  happen  a  year  or  two  years  from 
now.  A  mind  filled  with  mental  images  is  asleep  to  present  opportu- 
nities.— ^Wm.  E.  Towne,  in  The  Healthy  Home, 


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238  THE  DENTAL  DIGEST 

HOW  TO  MAKE  A  DENTIST  HAPPY 

Feb.  26,  1916. 
Editor  Dental  Digest: — 

I  am  enclosing  a  short  article  which  was  placed  in  our  local  pap)er 
some  time  ago  and  you  are  welcome  to  use  it  if  it  is  worth  the 
space.  It  certainly  has  had  a  fine  reaction  here  without  getting 
any  one  peeved.  I  wish  to  congratulate  you  on  the  good  stuflf  we 
get  in  the  Dental  Digest. 

Yours  truly, 

W.  H.  OnM. 

There  are  a  nimiber  of  ways  to  make  a  dentist  happy  but  the  following 
procedure  will  always  appeal  to  his  humor  and  bring  back  to  him,  with 
vividness  and  rejoicing,  that  moment  when  he  received  the  inspiration  to 
study  dentistry. 

As  a  prospective  patient  put  off  your  dental  work  just  as  long  as  you 
can  so  that  the  teeth  will  be  badly  broken  down  and  filthy.  They  will 
then  be  harder  to  fill  or  crown,  more  painful  and  in  general  less  satisfac- 
tory. Next  find  out  if  he  guarantees  his  work  for  twenty  years  or  fifty 
years.  A  reputable  physician  doesn't  do  this  but  a  dentist  ought  to. 
Be  sure  to  insist  on  getting  the  best  work,  which  takes  most  time  and 
best  material,  for  the  lowest  cost.  You  can't  buy  a  $20  suit  for  $10  in  a 
clothing  store  or  a  Cadillac  for  the  price  of  a  Ford,  but  of  course  in  den- 
tistry it  is  different. 

Upon  seating  yourself  in  the  dental  chair,  inform  the  dentist  how 
nervous  and  fussy  you  are,  how  brave  you  used  to  be  and  that  you  don't 
mind  anything  but  the  drilling.  As  soon  as  you  feel  the  slightest  indica- 
tion of  pain  grab  his  hand  and  make  him  apologize.  About  this  time 
get  pale  around  the  gills  and  pretend  to  faint;  this  will  cause  a  delay  and 
you  can  tell  your  friends  how  much  time  you  have  to  spend  in  the  dental 
office.  Don't  let  hitn  drill  very  thoroughly  because  this  hurts  and  insures 
better  work.  Do  not  attempt  to  keep  your  second  appointment,  after  the 
teeth  have  been  temporarily  treated  and  ache  stopped.  The  dentist's 
time  isn't  worth  much  and  he  won't  care,  especially  if  he  had  to  deny 
someone  else  the  opportunity  of  coming  because  of  your  appointment. 

When  the  work  is  finished  don't  pay  for  it  because  he  doesn't  need 
money.  He  gets  his  gold  and  materials  as  premiums  especially  since  the 
European  war.  Tell  him  you  will  pay  when  you  can  spare  it.  From 
then  on  do  not  go  near  the  office  for  at  least  a  year  or  two  and  avoid 
him  as  much  as  possible.  After  he  has  sent  you  several  statements  and 
threatens  to  employ  an  attorney,  call  or  send  someone  to  settle  the  ac- 


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THE  BUSINESS  SIDE  OF  DENTISTRY  239 

count.  Be  sure  to  tell  him  that  the  work  was  very  unsatisfactory  and 
has  been  aching  day  and  night  ever  since  it  was  completed  and  that  you 
expected  to  have  someone  else  do  it  over  again.  This  will  make  the 
dentist  regret  that  he  was  so  rude  in  trying  to  get  his  money.  If  you 
make  this  part  of  the  story  strong  enough  he  probably  will  cancel  the  debt 
entirely  and  pay  you  in  addition  for  your  inconvenience  and  humiliation. 

W.  H.  Ohm,  D.D.S. 


THE  BUSINESS  SIDE  OF  DENTISTRY* 

By  J.  J.  Simmons,  D.D.S. ,  Dallas,  Texas. 

The  boomerang  will  come  around  and  strike  your  own  head  in  time. 
In  this  connection  I  would  add,  that  he  who  is  wise  in  his  own  conceit 
becomes  a  liar  as  sure  as  the  night  follows  day.  True  wisdom  is  as  modest 
as  a  virgin,  as  timid  as  a  fawn,  and  as  generous  as  the  light  of  the  sun. 
It  knows  no  selfishness,  and  he  who  possesses  it  doesn't  lie. 

Charity  should  be  exercised  in  our  labors.  The  Lord  said  the  poor  ye 
have  with  you  always.  Twenty-five  per  cent,  of  mankind  works  and 
takes  care  of  the  other  75  per  cent.,  hence  you  should  do  your  share. 

With  reference  to  fees,  I  would  say  that,  as  a  whole,  the  dentist  earns 
what  he  gets,  yet  he  alone  is  responsible  for  the  .existing  conditions  if  he 
does  not  receive  enough  for  his  services. 

A  capital  plan  to  raise  prices  is  to  spend  spare  time  in  self-improvement 
not  only  as  regards  the  profession,  but  along  all  avenues  of  Ufe.  Reading 
enables  one  to  keep  in  touch  with  the  happenings  of  the  day  and  develops 
as  well  a  pleasing  personality,  and  one's  personality  is  one  of  the  greatest 
assets  in  securing  and  retaining  a  clientele  to  be  desired. 

Regular  exercise  and  vacations  tbne  up  the  system  and  strengthen 
one  morally,  mentally  and  physically.  Correct  habits  enable  the  dentist 
to  render  better  service  to  his  patients  and  attract  the  better  class. 

Breadth  of  thought  toward  your  professional  brethren  makes  the 
business  of  dentistry  more  genteel  to  us,  to  them,  and  beyond  doubt  it 
raises  us  in  the  estimation  of  the  laity. 

CLOSING  REMARKS    (dR.    SIMMONS) 

One  of  the  things  that  seems  to  be  rather  uppermost  in  the  minds  of 

all  of  you  is,  '*  How  to  get  the  money  "?    Now  I  don't  have  much  thought 

of  money.    I  have  fixed  a  rule  for  myself,  and  if  you  will  permit  a  little 

personal  reference — I  work  while  I  work  and  play  while  I  play.     One  of 

*Abstract  from  paper  presented  at  January  meeting  of  the  Dallas  County  Dental  Society. 


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240  THE  DENTAL  DIGEST 

the  best  tributes  my  mother  ever  paid  me  was  when  she  said  that  she  had 
never  heard  me  discuss  my  business.  Leave  your  business  at  your  office; 
don't  take  it  home  and  go  to  bed  with  it;  it  won't  help  at  all.  Leave  your 
business  at  the  office. 

When  you  go  into  a  department  store,  did  you  ever  notice  how  the 
young  lady  who  waits  on  you  always  says,  "Cash  or  charge"?  Now 
have  your  business  fixed  so  that  you  will  be  able  to  make  money  out  of  it. 
If  you  haven't  the  nerve  to  ask  your  customers  for  the  money,  you  ought 
to  hire  somebody  to  do  it  for  you.  Now  I  have  a  little  red-headed  stenog- 
rapher in  my  office  who  has  one  fixed  idea  in  her  mind,  and  that  is  "get 
the  money,"  and  if  you  should  walk  into  my  office  and  ask  to  see  me 
about  professional  services  she  would  walk  right  up  to  you  and  say,  "Do 
you  want  to  make  a  deposit"?  She  never  lets  them  get  by,  I  don't  care 
who  it  is. 

In  our  desire  to  accomplish  things  in  this  life  brings  to  mind  a  little 
story  which  I  remember  and  which  may  be  worth  something  to  you. 
There  was  once  a  dog  named  Jack  who  lived  in  a  neighborhood  where 
there  were  a  lot  of  dogs  just  a  Uttle  bit  bigger  than  he  was  and  every  time 
he  got  away  from  home  these  dogs  would  tear  out  after  him  and  he  would 
tear  out  home.  He  just  couldn't  stand  the  pressure;  it  was  too  much  for 
him.  His  master  decided  to  go  away  and  started  on  his  journey.  So 
Jack  thought  he  would  like  to  go  and  started  out  following  just  behind, 
and  every  now  and  then  some  dogs  would  run  out  and  almost  eat  him  up 
and  then  leave  him,  and  he  would  have  to  run  and  catch  up  with  the  wa- 
gon again.  One  day  while  they  were  on  the  journey  and  Jack  was  running 
alongside  he  dropped  into  a  bear  trap  and  before  he  knew  he  had  hit  the 
bottom.  He  looked  all  around  and  then  he  saw  the  bear..  He  knew  he 
was  cornered  and  so  he  said  to  himself:  "Now,  Jack,  you  have  been  a  little 
coward  all  of  your  life;  you've  never  had  any  nerve;  right  here's  where  you 
will  have  to  fight  for  your  Ufe — you  are  going  to  mix  up  with  this  bear;" 
and  so  when  he  had  said  this  to  himself  he  felt  better  and  he  started  in 
and  for  once  in  his  life  Jack  made  a  fair  fight  and  came  out  victor.  He 
was  so  pleased  with  himself  that  he  started  in  from  that  time  on  and  he 
whipped  every  big  dog  he  came  across  and  he  made  up  his  mind  that 
when  he  got  back  home  he  was  going  to  whip  that  old  crowd.  He  had 
found  his  place — he  had  become  a  victor  by  having  adjusted  himself 
after  having  found  his  place,  and  Jack  died  a  beloved  and  brave  dog. 

It  is  just  as  easy  for  every  dentist  in  the  city  of  Dallas  to  make  a 
good  business  man,  if  we  will  just  assert  ourselves  and  use  our  talents, 
use  good  judgment. 

Get  up  every  morning  with  one  word  in  your  mind,  "Deposit,"  and  if 
you  will  do  that  you  will  get  the  money. — The  Texas  Denial  Journal, 


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THIS  PATIENT  FRANKLY  LEAVES  THE  REWARD  TO  GOD         241 


THE  DENTIST'S  OFFICE  HOURS 

The  following  table  received  from  Fawcett  &  Fawcett,  Brooklyn, 
shows  that  all  of  this  agitation  about  the  number  of  office  hours,  number 
of  income  hours,  overhead  expense,  remuneration,  average  fees  and  that 
sort  of  thing,  is  entirely  unnecessary. 

Do  you  see  the  catch? 

365  Days  in  the  year — 24  hours  each. 

122  Sleep  8  hours. 

243 

122  Pleasure  8  hours. 

121 
52  Sundays. 

69 

26  Saturdays  J  days. 

43 

14  Vacation. 

29 

13  Legal  Holidays. 

16 

15  Lunch. 

I  O  Yom  Kipur. 
Hence  you  do  no  work  at  all  in  the  365  days  from  actual  accounting. 


THIS  PATIENT  FRANKLY  LEAVES  THE  REWARD  TO  GOD* 

It  isn't  often  that  a  patient  speaks  his  mind  right  out  in  this  way,  but 
many  of  them  practise  the  belief  that  God  is  the  one  to  reward  the  den- 
tist. 

This  letter  was  received  by  a  prominent  dentist  in  India. — Editor. 

Drs.  Smith  Bros. 
American  Dentists 
Sir:— 

I  have  been  suffering  from  tooth  disease  for  a  very  long  time,  I  will 

give  below  the  present  state  of  my  teeth  and  humbly  request  you  to 

•Courtesy  of  Dr.  W.  P.  Heaney. 


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242  THE  DENTAL  DIGEST 

kindly  give  me  free  advise  for  which  God  will  reward  you.  I  have  used 
all  sorts  of  medicines  but  failed.  Blood  always  comes  out  from  the  roots 
of  my  teeth.  If  the  gums  are  pressed  with  finger  ends  a  kind  of  matter 
pus  comes  the  smell  of  which  is  bad,  consequently  very  bad  smell  comes 
out  always  from  my  mouth,  but  do  not  feel  any  pain,  of  course  they 
shake  a  little.  My  age  is  30.  The  material  like  cement  which  is  at- 
tached to  the  gums  have  all  gone.  My  digestive  power  is  very  weak  and 
irregular.  I  think  the  reason  of  it  are  that  food  which  I  eat  are  mixed 
with  blood  when  chewing  to  get  into  the  belly,  thus  causing  indigestion. 
Also  when  laughing  and  feel  a  slight  hurt  into  my  face,  blood  comes  out 
which  smells  bad. 

I  beg  you  kindly  send  a  prescription  for  which  act  of  kindness  I  will 
ever  remain  ever  gratefully  yours. 

I  remain  yours 


Editor  Dental  Digest: — 

On  page  815,  December  191 5  Digest  is  an  article  taken  from  Deutsche 
Medizinische  Wochenschrijt^  August  19,  and  called  '*  Fatal  Case  of  Pyor- 
rhea Alveolaris." 

The  history  of  that  case,  as  it  reads,  is  very  near  like  one  in  my  own 
practice  in  the  winter  of  191 3.  Man  about  thirty-five  years  of  age. 
The  trouble  looked  like  a  very  severe  case  of  pyorrhea.  I  first  extracted 
upper  left  ist  bicuspid,  then  in  about  two  weeks  the  second  bicuspid. 
They  would  not  heal  up.  Very  foul  breath.  I  soon  found  out  it  was 
something  I  had  never  met  with  before,  so  I  took  him  to  a  M.D.  He 
was  as  puzzled  as  I  was,  and  the  patient  finally  lost  all  the  teeth  on  left 
side  clear  up  to  and  including  the  right  central.  The  gums  would  not 
yield  to  treatment,  and  continued  to  discharge.  In  the  meantime, 
the  patient  had  fever,  lost  over  fifty  pounds  in  weight,  when  all  of  a 
sudden  (forty-eight  hours),  he  developed  very  severe  ulcers  of  throat. 
He  came  in  to  see  the  M.  D.  and  he  called  me  and  when  I  went  in  he 

said:     '*Dr.  J. ,  I  have  found  the  trouble.     This  man  has  syphilis." 

(This  was  about  three  months  after  I  first  saw  the  patient.)  He  pro- 
ceeded to  treat  for  same  and  was  pleased  to  soon  see  improvement.  The 
gums  soon  healed  up  and  this  winter  I  made  the  patient  a  partial  denture, 
and  he  seems  to  be  all  right  (to  outward  appearances)  again.  He  claims 
never  to  have  had  any  venereal  disease. 

E.  G.  J. 


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AN  ANSWER  TO  A  QUERY  243 

THE  EFFICIENCY  OF  THE  "TRUBYTE  TEETH" 

By  George  W.  Weld,  D.D.S.,  M.D.,  New  York  City 

I  am  prompted  to  relate  the  history  of  one  case  of  a  full  upper  and 
lower  denture  which  would  seem  to  emphasize  the  importance  and  ne- 
cessity in  certain  cases,  at  least,  of  making  use  of  the  **Trubyte"  teeth  in 
conjunction  with  the  Gysi  Adaptable  Articulator.  Mr.  U.  R.  called  upon 
me  March  5th,  1915,  for  consultation.  He  informed  me  that  during  the 
past  five  years  he  had  seven  sets  of  teeth  made  by  as  many  different  den- 
tists and  that  he  was  almost  discouraged  of  ever  finding  a  dentist  who 
could  make  him  a  set  that  he  could  wear  with  comfort  and  usefulness. 

On  examination,  I  found  one  of  the  most  difficult  cases  that  had  ever 
come  under  my  observation. 

In  company  with  my  patient,  I  called  upon  Dr.  James  P.  Ruyl  for 
consultation  and  help.  Proper  measurements  were  taken  and  the  appro- 
priate teeth  selected.  The  teeth  were  articulated  and  ground  up  a  la 
Gysi,  and  inserted  in  the  mouth. 

I  am  now  able  to  report  that  the  gentleman  was  enthusiastic  over  the 
result  saying  "I  am  convinced  as  you  told  me,  in  the  beginning,  that 
the  Trubyte  Teeth  and  the  Gysi  articulators  have  proved  indispensable 
in  my  case,  for  proper  comfort,  and  efficient  mastication  purposes." 


AN  ANSWER  TO  A  QUERY 

What  metal  is  best  for  castings,  to  be  used  under  gold  crowns,  for 
the  purpose  of  building  up  badly  decayed  roots  to  support  crowns? 
Would  there  be  danger  in  using  coin  silver,  containing  10  per  cent,  copper, 
in  case  the  crown  failed  and  exposed  the  coin  silver  to  the  secretions  of 
the  mouth? 

In  answer  to  above  (page  115,  February  issue  of  Dental  Digest) — 
would  suggest  using  Westoria  New  Metal,  in  preference  to  coin  silver  or 
an  alloy  of  silver  as  this  will  not  corrode  when  exposed  to  saliva  and  also  is 
much  cheaper  than  silver.  We  very  frequently  cast  practically  a  whole 
tooth  out  of  it,  and  I  have  never  seen  a  case  where  it  corroded. — B.  C. 
Taylor,  North  Wilkesboro,  N.  C. 


One  of  our  correspondents  handed  us  the  following  which  we  con- 
sider worth  time  for  reflection:  "Income  is  the  result  and  measure  of 
ideas  and  effort. '*  It  looks  logical  if  you  consider  the  business  side  of 
dentistry  as  a  part  of  the  aforesaid  ideas. — Nebraska  Dental  Journal. 


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siGTicM.  Urns 


[This  department  is  in  charge  of  Dr. 
V.  C.  Smedley,  604  California  Bldg., 
Denver,  Colo.  To  avoid  unnecessary  de- 
lay, Hints,  Questions,  and  Answers  should 
be  sent  direct  to  him.]* 

Securing  Brightness  in  Aluminum-Rubber  Plates.— The  hydro- 
gen sulfid  liberated  in  vulcanizing  has  a  tendency  to  darken  the  aluminum 
in  alimiiniun-rubber  plates.  To  avoid  this,  the  aluminum  base-plate  is 
covered  with  shellac  or  sandarac. — Zahnaenztliche  Rundschau  {The 
Dental  Cosmos.) 

A  Useful  Application  for  Sore  Lips  While  Operating  .  — A  little 
collodion  is  very  useful  to  apply  to  sore  lips  before  beginning  to  operate. 
It  takes  out  the  soreness,  protects  the  lips,  and  they  heal  rapidly  after 
the  application.  It  is  also  useful  to  wounds  on  the  hands,  reducing  the 
danger  of  infection  and  washing  will  not  remove  it. — Pacific  Dental 
Gazette, 

Repairing  Punctures  in  Rubber  Dam  After  Adjusting. — ^Take  a 
piece  of  surgeon's  adhesive  plaster  of  the  proper  size,  slightly  warm  it 
and  cover  the  punctures.  It  will  effectually  seal  the  opening. — Pacific 
Dental  Gazette. 

A  Loose  Pin  Banded  Crown  Especially  Adapted  for  Upper 
Lateral  Incisors. — Prepare  the  root  the  same  as  for  a  Richmond,  being 
certain  that  you  have  the  enamel  removed  and  not  beveled.  Fit  band 
and  trim  to  contour  or  outline  of  gum.  Then  remove  band,  place  on  end 
of  block  of  soft  wood  and  place  crown  in  band  and  swage  slightly.  The 
crown  should  be  a  trifle  larger  than  the  band  and  ground  to  a  very  slight 
bevel  before  swaging;  then  place  band  on  root  again,  after  having  ground 
crown  to  fit  root,  and  swage  again  directly  against  the  root.  Then  re- 
move and  if  you  wish  gold  partition  between  crown  and  root,  cut  disk  to 
fit  about  to  the  centre  of  the  band  vertically;  again  replace  band  and  press 
disk  up  against  root.  Take  impression,  remove,  invest  and  solder  disk 
into  band,  using  as  little  solder  as  possible.  Then  remove  and  drill  hole 
large  enough  to  receive  pin,  but  not  the  collar;  replace  band  on  root,  press 
pin  in  up  to  collar  and  with  sharp  pointed  instrument  outline  collar,  re- 
move and  cut  to  outline.    You  are  now  ready  to  polish  and  cement. 

♦In  order  to  make  this  department  as  live,  entertaining,  and  helpful  as  possible,  ques- 
tions and  answers,  as  well  as  hints  of  a  practical  nature,  are  solicited. 


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PRACTICAL  HINTS  245 

Having  root  dried,  fill  hole  in  crown  with  cement  and  place  pin  part  way, 
then  put  some  cement  on  both  sides  of  centre  disk  in  band;  then  fill  hole 
in  root  and  put  on  the  crown  and  you  have  a  crown  as  serviceable  as  any, 
and  in  case  of  repair,  easily  and  quickly  done. — B.  A.  Wright,  D.D.S., 
Latrobe,  Pa,  The  Dental  Summary, 

To  Repair  Gold  Crowns. — ^To  repair  crack  or  hole  in  gold  crown, 
burnish  over  same  piece  22  or  24  karat  gold  sufficiently  large  to  cover 
space;  flow  upon  same  14  or  18  karat  gold  solder,  place  it  upon  crack  or 
hole  with  soldered  portion  in  contact  with  latter,  hold  together  with  pliers, 
heat  gently,  and  patch  will  adhere  readily  to  crown. — J.  A.  Richards, 
D.D.S.,  BfoomeWs  ''Practical  Dentistry r 

A  Gasolene  Soldering  Outfit. — Necessity  is  the  mother  of  this 
little  discovery,  which  may  be  of  some  benefit  to  other  practitioners.  If 
no  gas  supply  is  available  for  soldering,  one  has  to  depend  on  one  of  the 
various  gasolene  outfits  for  the  laboratory.  Anyone  who  has  stood  on 
one  foot  over  a  hot  blowpipe  on  a  hot  summer  day,  pumping  bellows  with 
the  other,  can  appreciate  the  relief  this  arrangement  will  -afford. 
A  Red  Devil  water  motor,  costing  $3;  a  Vernon  rotary  compressor, 
costing  $7.50,  and  a  Buffalo  gasolene  gas  tank  and  blowpipe  are  secured. 
The  pulley  wheel  is  removed  from  the  Vernon  compressor,  and  a  sleeve 
connection  made  connecting  the  axle  of  the  compressor  and  the  water 
motor,  thereby  obtaining  a  direct  shaft  drive.  The  compressor  and  the 
gasolene  tank  are  then  connected  with  tubing  of  the  desired  length.  Then 
the  water  is  turned  on  the  motor,  and  with  the  correct  quantity  of  gasolene 
at  the  proper  temperature  in  the  tank,  soldering  can  be  done  with  the 
same  comfort  as  with  a  gas  outfit.  I  am  using  this  arrangement  every 
day,  and  find  it  to  work  perfectly. — C.  G.  Baker,  Act.  Dent.  Surg.,  U.  S. 
Army,  The  Dental  Cosmos. 

How  TO  Remove  Broken  Instruments. — For  difficulties  of  removing 
the  fragment  of  an  instnunent  from  a  root  canal, — especially  if  it  has 
become  embedded  in  the  apical  third, — and  the  inadequacy  of  the  gen- 
erally advised  means  for  removal,  I  would  recommend  section  of  the  root, 
guided  by  the  aim  of  saving  as  much  tooth  structure  as  possible.  My 
method  of  operation  consists  in  turning  over  a  flap  of  mucous  membrane 
under  local  anesthesia,  and  making  a  windowlike  opening  in  the  alveolus 
with  the  aid  of  a  fine,  sharp  chisel;  the  location  of  this  opening  to  be  de- 
termined by  the  x-ray  picture.  The  root  thus  exposed  is  opened  in  its 
long  axis  with  a  fine  rosehead  bur,  the  embedded  instrument  is  quickly 
exposed  to  view,  and  pushed  out  in  the  direction  of  the  pulp  chamber  with 
stout,  curved  sounds.  In  order  to  avoid  an  oversight  or  swallowing  of  the 
broken  instrument,  a  pellet  of  cotton  has  been  previously  introduced  into 


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246  THE  DENTAL  DIGEST 

the  pulp  chamber  in  order  to  engage  the  fragment  upon  removal.  The 
incision  in  the  root  is  then  fi^ed  with  tin,  gold  or  amalgam,  the  limien  of 
the  canal  being  preserved  by  a  sound  previously  introduced  into  the  canal. 
If  the  canal  has  been  opened  up  to  the  apical  foramen,  this  sound  is  super- 
fluous, as  an  hermetic  sealing  of  the  canal  is  desirable.  The  field  of  opera- 
tion is  carefully  cleansed  and  sterilized,  and  the  wound  in  the  mucous 
membrane  closed  by  a  suture.  This  operation  is,  of  course,  most  favor- 
ably indicated  in  single-rooted  teeth.  It  has  the  advantage  over  resection 
of  the  root  apex,  as  recommended  by  Williger  (see  Dental  Cosmos,  No- 
vember, 191 2,  p.  1289),  that  the  amount  of  injury  inflicted  upon  the 
tooth  is  very  small,  a  slit  of  i  mm.  breadth  being  sufficient,  and  that  a 
very  small  portion  only  of  alveolar  bone  need  be  removed,  since  the 
broken  instrument  is  removed  by  way  of  the  pulp  chamber. — E.  Schus- 
ter, Leipsig,  Deutsche  Monatssckrift  fuer  Zaknheilkunde.  {American 
Denial  Journal.) 

Hypodermic  Syringes. — If  your  all-metal  hypodermic  syringe 
'* leaks  back,"  take  out  the  leather  washer  and  replace  with  a  strand  or 
two  of  asbestos  *'rope."  This  answers  the  purpose  better  than  leather, 
and  will  stand  boiling  without  materially  affecting  same. — J.  Fred 
Gordon,  Albury,  N.  S.  W.,  Commonwealth  Dental  Review. 


QUESTIONS  AND  ANSWERS 

Question. — Will  you  or  some  of  your  readers  tell  me  if  the  glass  or 
formaldehyde  sterilizer  for  dental  instruments  is  efficient  and  thorough? 
I  saw  much  advertising  for  different  makes  of  that  kind  of  sterilizer 
several  years  ago,  but  in  the  last  year  or  so  I  haven't  seen  any,  or  any 
writing  at  all,  about  them. 

Also  would  like  to  know  of  a  practical  way  of  sterilizing  handpieces. 
— H.  E.  S. 

Answer. — The  formaldehyde  sterilizer  (preferably  the  glass  one)  is  in 
quite  general  use,  I  understand,  to  keep  instruments  in  weak  solution 
after  they  have  been  sterilized  by  boiling.  The  solution  strong  enough 
for  sterilization  has  quite  a  disagreeable  odor.  I  know  of  one  case  where 
a  dentist  used  it  for  sterilization  for  a  year  or  two,  dipping  his  hands  into 
the  liquid  daily  until  his  hands  became  sore  and  remained  so  for  a  number 
of  weeks— formaldehyde  poisoning  he  thought. 

I  believe  the  most  practical  way  to  sterilize  handpieces  is  to  immerse 
them  in  60  per  cent,  alcohol.  Let  them  run  in  same  for  a  minute  between 
patients  and  then  let  them  soak  in  it  over  night.  Wipe  off  and  oil  before 
using,  as  alcohol  kills  the  lubricant. — V.  C.  S. 


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PROPOSED  STATEMENT  OF  AIMS 

n  n  n  ml  ahd  objects- 

FEDERATION  OF  MEDICAL  ECONOMIC  LEAGUES 

This  statement,  taken  from  The  Medical  Economist's  Official  Organ 
of  the  Federation  of  Medical  Economic  Leagues,  contains  some  sugges- 
tions of  more  than  passing  interest  to  dentists,  and  especially  the  refer- 
ence to  administration  of  anaesthetics.  The  whole  thing  is  worth  your 
perusal  as  it  shows  a  movement  in  medical  circles  which  looks  like  ''busi- 
ness."— Editor. 

The  Federation  of  Medical  Economic  Leagues  has  for  its  objects  the 
protection  and  promotion  of  the  economic  and  professional  interests  of  all 
medical  men,  the  increase  of  the  usefulness  of  the  medical  body  to  the 
community,  and  the  conservation  of  the  public  welfare.  Holding  that 
these  objects  are  not  opposed,  but,  on  the  contrary,  are  intimately  con- 
nected with  one  another;  that  the  public  is  best  served  when  the  economic 
and  social  status  of  the  medical  profession  is  conmiensurate  with  the  im- 
portance of  its  communal  duties;  and  that  the  important  changes  which 
have  taken  place  and  are  still  taking  place  in  our  social  organization  re- 
quire a  careful  readjustment  of  medical  practice  to  accord  with  the  needs 
of  the  times: — the  Federation  declares  its  aims  to  be  the  following: 

I.  To  organize  the  profession  on  a  democratic  basis,  creating  a 
medical  body  politic  that  shall  include  all  legal  practitioners  of  medicine; 
to  the  end  that  both  its  external  and  its  internal  adjustments  may  be 
developed  as  the  true  interests  of  the  public  and  the  profession  require. 

n.  To  study  the  economics  of  medical  practice  in  its  modern  develop- 
ments, and  the  means  of  adapting  its  present  conditions  to  changing  social 
requirements. 

III.  To  publicly  represent  the  medical  profession,  and  to  inform  the 
community  of  its  legitimate  needs  and  aspirations;  we  holding  that  want 
of  general  information  is  the  occasion  of  much  present  maladjustment. 

IV.  To  promote  and  foster  in  our  own  ranks  that  spirit  of  justness 
and  fairness  in  our  mutual  and  civic  relations  that  will  render  formal 
codes  of  ethics  unnecessary. 

V.  To  secure  for  the  practitioner  proper  recognition  and  just  com- 
pensation for  his  work;  and  to  equalize  the  burdens  of  communal  charity, 
which  the  present  system  inequitably  disposes  to  our  disadvantage. 

♦Submitted  by  the  special  Conmiittee,  Feb.  i,  191 6. 


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248  THB  DENTAL  DIGEST 

VI.  To  oppose  any  curtailment  of  the  necessary  rights  and  privileges 
accorded  to  physicians  who  conform  to  legal  requirements. 

VII.  To  cooperate  whenever  possible  with  dvic  and  private  bodies 
whose  endeavors  bear  relationship  to  the  public  health  or  to  medical 
practice;  to  favor  the  enactment  and  enforcement  of  just  and  uniform 
medical  laws;  and  to  oppose  medical  legislation  that  is  detrimental  to  the 
public  interest,  or  improperly  encroaches  on  medical  practice. 

VIII.  To«  raise  the  standard  of  medical  education  of  licensed  practi- 
tioners as  well  as  of  undergraduates;  to  which  end  the  opportunities  for 
observation  and  study  that  are  afforded  by  public  institutions  should  be 
open  to  the  profession  at  large,  and  not  be  monopolized  by  a  few  individ- 
uals. 

The  more^immediate  objects  of  the  Federation  of  Medical  Economic 
Leagues  in  New  York  are : 

1.  To  discourage  and  gradually  to  abolish  the  present  system  of  volun- 
teer medical  work  in  our  public  and  private  medical  institutions,  which  is 
inefficient  and  unjust  to  the  workers;  and  to  substitute  therefore  a  system 
which  shall  place  the  community  work  done  by  the  medical  profession  on 
the  same  plane  as  that  done  by  other  members  of  the  body  politic.  We 
hold  that  medical  services  in  hospitals,  dispensaries,  and  similar  institu- 
tions should  be  paid  for,  as  all  other  services  are  paid  for. 

2.  To  uphold  and  support  the  health  authorities  in  all  their  legitimate 
activities  in  sanitation  and  disease  prophylaxis,  but  to  oppose  their  en- 
trance into  the  field  of  disease  treatment.  The  public  charities  depart- 
ment can  and  should  take  care  of  the  indigent  sick;  and  we  regard  the 
establishment  of  public  clinics  by  the  Health  Department  for  the  treat- 
ment of  special  diseases  as  an  unnecessary  expense  which  pauperizes  the 
community  and  injures  the  medical  profession. 

3.  To  oppose  the  indiscriminate  administration  of  medical  charity 
by  public  and  semi-public  institutions;  to  enforce  the  principle  that, 
when  supplied  without  honest  investigation  and  on  the  same  basis  as  any 
other  poor  relief,  it  is  detrimental  to  the  entire  conununity;  and  to  secure 
the  enactment  and  enforcement  of  efficient  regulations  for  this  purpose 
in  the  place  of  the  present  ineffective  law. 

4.  To  oppose  all  projected  laws  or  amendments  of  laws  that  would 
permit  individuals  not  possessed  of  the  prerequisite  educational  require- 
ments, and  not  examined  and  licensed  by  the  State  as  practitioners  of 
medicine,  to  practice  medicine  in  any  form  or  under  any  subterfuge,  or 
to  assume  any  of  the  duties  or  responsibilities  of  physicians. 

5.  To  safeguard  the  rights  and  promote  the  equitable  interests  of 
medical  men  under  the  various  enacted  and  projected  schemes  of  State 


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ADVICE  TO  THOSE  ABOUT  TO  WEAR  ARTIFICIAL  TEETH  249 

Industrial  and  State  Health  Insurance;  and  to  prevent  the  individual 
exploitation  of  medical  practitioners  in  them  by  corporate  interests. 

6.  To  gradually  extend  to  all  licensed  physicians,  under  proper  safe- 
guards, the  facilities  for  caring  for  their  patients  in,  and  the  opportunities 
for  study  and  improvement  afforded  by,  the  public  medical  institutions 
of  the  dty  and  state;  we  holding  that  a  license  by  the  state  to  practice 
medicine  in  the  commimity  at  large  necessarily  connotes  the  ability  to 
care  for  its  individual  members  when  they  have  become  public  charges. 


ADVICE  TO  THOSE  ABOUT  TO  WEAR  ARTIFICIAL  TEETH 

By  D.  W.  Barker,  M.  D.  S.,  Brooklyn,  N.  Y. 

The  advice  here  given  has  been  a  help  to  others  and  may  be  a  help 
to  you.  You  are  now  about  to  begin  to  learn  to  do  something  you  have 
never  done  before — to  use  an  artificial  substitute  for  natural  organs 
(teeth)  and,  however  perfect  they  may  be,  they  are  not  equal  to  the 
natural  teeth,  nor  are  they  used  in  the  same  way. 

Do  not  expect  to  acquire  facility  in  the  use  of  these  new  things  at  once. 
That  comes  only  by  practice,  patience  and  time.  You  cannot  learn  it  in 
a  few  days,  or  a  few  weeks.  You  will  learn  it  a  little  at  a  time,  day  by  day, 
gradually  acquiring  conunand  over  them.  In  a  month  or  two  you  should 
acquire  a  considerable  degree  of  skiU.  Above  all,  do  not  become  dis- 
couraged and  get  the  notion  that  your  experience  is  in  any  way  different 
from  that  of  other  beginners.  All  others  who  wear  artificial  teeth  have 
to  go  through  this  process  of  self  education.  The  dentist  may  do  his 
part  perfectly,  but  this  is  something  that  you  have  to  do  for  yourself; 
no  one  can  do  it  for  you,  and  unless  you  do  it  your  teeth  will  not  be  a 
success.  You  should  not  allow  yourself  to  get  into  the  habit  of  leaving 
the  teeth  out.  To  do  so  is  to  incur  a  distinct  loss,  for  no  one  ever  learned 
to  use  a  set  of  teeth  by  wearing  them  in  the  pocket  or  the  bureau  drawer. 
You  can  learn  to  use  them  only  by  using  them,  just  as  a  child  learns  to 
walk  by  walking,  though  imperfectly  at  first. 

There  are  two  things  that  will  take  you  longer  to  learn  than  anything 
eke,  namely,  talking  and  eating.  I  will  consider  them  separately.  In 
speaking  there  are  certain  sounds  that  are  apt  to  be  more  difficult  than 
others;  s,  x,  ch  and  sh  are  the  worst.  A  good  way  to  overcome  this  diffi- 
culty is  to  practise  reading  aloud.  Do  it  alone  so  there  will  be  none  to 
attract  your  attention.  Read  slowly  and  make  it  a  point  to  enunciate 
each  syllable  distinctly.  When  you  meet  with  a  word  that  bothers  you, 
stop  and  say  it  over  and  over  until  you  can  say  it  distinctly.    Remember 


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250  THE  DENTAL  DIGEST 

you  are  training  the  muscles  to  obey  the  will  very  much  as  a  child  does 
in  learning  to  talk.  The  more  this  simple  and  easy  exercise  is  practised 
the  quicker  you  will  be  able  to  speak  distinctly.  Following  this  plan 
most  of  the  difficulties  of  speech  will  disappear  in  a  few  days. 

Learning  to  eat  with  them  will  take  you  somewhat  longer,  but  the 
principle  is  the  same.  Don't  expect  to  eat  your  first  meal  with  your  new 
teeth  just  as  you  did  with  your  natural  teeth,  nor  just  as  someone  else 
does  who  has  worn  artificial  teeth  for  many  years,  for  you  won't  do  it;  no 
one  ever  does  it.  I  used  to  know  a  dentist  who  would  tell  his  patients 
not  to  yield  to  the  temptation  to  take  out  their  teeth  at  their  first  meal 
and  they  would  not  want  to  take  them  out  the  second  time.  This  I 
consider  bad  advice,  because  the  patient  is  apt  to  become  discouraged  at 
his  failures,  and  get  the  idea  that  there  is  something  wrong  with  the  teeth 
or  himself.  If  you  become  discouraged  and  lose  confidence  in  your 
ability,  the  teeth  will  not  be  the  success  that  they  should  be.  Therefore, 
I  would  not  advise  a  beginner  to  try  to  do  too  much  at  first.  If  you  only 
eat  part  of  the  first  meal  with  them  you  are  doing  very  well.  Gradually 
increase  the  length  of  time  at  each  meal,  eating  slowly,  and  in  a  few  days 
with  increased  confidence  and  control,  which  comes  by  practice,  the  whole 
meal  can  be  essayed.  Even  then  you  will  find  you  are  learning  something 
more  every  day  and  as  the  days  pass  an  increased  efficiency  is  acquired. 
If  you  attempt  to  bite  upon  a  hard  substance,  like  an  apple  or  an  ear 
of  com,  you  will  probably  trip  them,  for  this  is  a  severe  strain  upon  the 
suction.  It  may  be  accomplished,  however,  by  pressing  the  apple  firmly 
upward  against  the  teeth  at  the  moment  of  biting  upon  it.  This  may  be 
tested  with  the  finger,  and  it  will  be  found  quite  impossible  to  trip  them. 

Some  people  acquire  a  habit  (after  their  teeth  have  been  extracted) 
of  holding  a  handkerchief  over  the  mouth  when  in  the  act  of  laughing. 
If  you  have  such  a  habit  you  should  break  yourself  of  it  at  once,  for  the 
action  directs  the  attention  of  the  observer  to  the  mouth;  if  you  do  not 
make  the  motion  no  one  will  think  of  looking  there. 

"Shall  I  keep  them  in  at  night?''  is  a  question  often  asked  by  a  be- 
ginner. To  this  I  answer,  **  Xo,  not  right  away,  because  they  would  keep 
you  awake.  But  after  you  have  become  accustomed  to  them  you  may 
try  it  if  you  think  you  would  be  more  comfortable.  It  is  just  as  you 
find  it  most  comfortable. " 

If  you  find  that  your  plate  makes  a  sore  spot,  usually  somewhere 
along  the  edge,  this  is  not  an  indication  that  the  plate  does  not  fit  prop- 
erly, but  merely  that  there  is  a  little  too  much  pressure  at  that  particular 
spot  which  should  be  relieved  by  filing  off  a  little.  Almost  all  new  plates 
have  to  be  relieved  in  this  way.  Return  to  the  dentist  while  the  place 
is  sore  (not  after  it  has  gotten  well)  and  he  will  know  how  much  to  file  it  off. 


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AN  EPITOMB  OF  CURRENT  DSNTAL  AND  MEDICAL  LITERATURE    251 

Your  artificial  teeth  should  be  kept  dean.  To  do  this  they  should 
be  carefully  and  thoroughly  scrubbed  with  a  stiff  brush  several  times  a 
day  (after  each  meal  if  practicable).  A  tooth  brush  is  not  a  good  brush 
for  this  purpose.    A  small  hand  scrub  brush  is  much  better. 

In  conclusion,  I  wish  to  urge  you  to  give  no  heed  to  the  teasing  or 
joking  comments  of  your  friends.  In  most  cases  it  has  no  serious  mean- 
ing, but  may  arouse  dissatisfaction  in  your  mind  where  no  cause  for  dis- 
satisfaction really  exists. — The  Dental  Summary. 


AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE 

[The  Denial  Cosmos,  March,  191 6] 
Original  Communications 

War  Dental  Surgery:  Some  Cases  of  Maxillo-facial  Injuries  Treated  in  the  Dental  Section 

of  the  American  Ambulance  at  Neuilly  (Paris),  France.    By  Dr. 'Geo.  B.  Hayes. 
•The  Innervation  of  Dentin.    By  J.  Howard  Mummery,  D.Sc.,  M.R.C.S.,  L.D.S. 
The  Porcelain  Inlay  in  Europe.     By  N.  S.  Jenkins,  D.D.S. 

The  Evolution  of  the  Human  Face  and  Its  Relation  to  Head  Form.    By  Dr.  E.  A.  Hooton. 
The  Design  and  Retention  of  Partial  Dentures.    (I).  By  Douglas  Gabell,  M.R.C.S.,  L.R.C.P. 

L.D.S. 
Sanitary  Dental  Cuspidors  on  Board  Ships.    By  J.  D.  Halleck,  B.S.,  D.D.S. 
The  Importance  of  Biology  as  Applied  to  Dentistry.     (II).    By  Dr.  Ch.  F.  L.  Nord. 
Precautions  to  be  Observed  in  the  Care  of  Mouth  Infections  with  Regard  to  the  Preservation 

of  Health.    By  W.  Stirling  Hewitt,  D.D.S. 
Methods  of  Teaching  Orthodontics  to  Dental  Students.    By  S.  H.  Guilford,  A.M.,  D.D.S., 

Ph.D. 
Public  Dental  Services.    By  Walter  Harrison,  L.D.S.,  D.M.D. 
The  Germicidal  Efficiency  of  Dental  Cements.    By  Paul  Poetschke. 
Prophylactic  Treatment  at  Different  Ages.    By  Prof.  Albin  Lenhardtson. 

THE  INNERVATION  OF  DENTIN 

By  J.  Howard  Mummery,  D.S.C,  M.R.C.S.,  L.D.S. 

POINTS  DEMONSTRATED  BY   THE  WRITER'S  PREPARATIONS 

(i)  That,  at  all  events  in  actively  growing  teeth,  there  is  a  considera- 
ble supply  of  non-meduUated  or  efferent  fibers  to  the  tooth  pulp,  which 
are  derived  from  sympathetic  ganglia  and  not  concerned  in  any  way  with 
the  sensitiveness  of  the  dentin,  their  ultimate  fibrils  probably  being  dis- 
tributed to  the  coats  of  the  bloodvessels  and  the  secreting  cells  of  the 
pulp;  whether  any  fibers  of  this  system  enter  the  dentinal  tubes  it  seems 
impossible  to  determine. 

(2)  That  at  the  comua  of  the  tooth  pulp,  the  bundles  of  medullated 
nerve  fibers  lose  their  medullary  sheath  and  neurolemma,  and  the  axis 


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252  THB  DBIITAL  DIGEST 

cylinder  expands  into  a  spreading  mass  of  neurofibrils,  which  can  be 
traced  directly  to  the  dentinal  tubes,  which  they  enter. 

(3)  That  in  young,  growing  teeth,  these  fibers  at  the  comua  are  very 
abundant,  and  have  a  wavy  course;  they  appear  to  consist  of  bundles  of 
neurofibrils  in  many  instances,  and  these  vary  much  in  diameter,  the 
further  divisions  of  these  bxmdles  probably  taking  place  in  the  tubes  of 
the  dentin. 

(4)  That  at  the  lateral  portions  of  the  pulp,  the  neurofibrils  passing 
from  the  main  nerve  trunks  enter  into  an  intricate  plexus  beneath  the 
odontoblasts,  and  are  again  collected  into  larger  strands  of  neurofibrils, 
which  mostly  pass  directly  into  the  dentinal  tubes.  They  also  demon- 
strate the  different  appearances  of  these  strands  of  fibrils,  some  being 
large  and  showing  bead-like  enlargements  at  intervals,  other  finer  fibers 
having  a  minutely  dotted  appearance. 

(5)  That  where  the  pulp  is  separated  from  the  dentin,  the  nerve  fibers 
seem  to  be  pulled  out  from  the  pulp  and  from  the  dentinal  tubes,  and 
stretch  across  the  interval,  evidently  under  considerable  tension. 

(6)  That  .the  nerve  fibers  enter  the  dentinal  tubes  in  company  with 
the  dentinal  fibril. 

THE  IMPORTANCE  OF  BIOLOGY  AS  APPLIED  TO  DENTISTRY 
By  Dr.  Ch.  F.  L.  Nord,  Gorincheh,  Holland 

CONCLUSIONS 
In  closing,  I  wish  to  draw  the  following  conclusions: 
(i)  The  decline  of  the  teeth  must  especially  be  ascribed  to  panmixia, 

and  cannot  be  considered  as  a  symptom  of  degeneration  according  to  the 

present  stage  of  biological  science. 

(2)  The  connection  between  anomalies  of  the  teeth  and  other  deformi- 
ties (hair  and  eye  diseases,  deft  plate,  etc.)  is  probably  caused  by  the 
inferior  quality  of  a  certain  hereditary  variant,  which  is  the  cause  of  all 
these  anomalies. 

(3)  Anomalies  of  the  teeth,  so  far  as  they  are  not  brought  about  by 
apparent  external  causes,  must  be  considered  as  hereditary,  and  it  is  there- 
fore of  great  importance  to  make  a  careful  researjch  into  the  facial  relations 
of  the  family  of  the  patient  before  beginning  treatment. 

(4)  Whereas  dental  anomalies  of  all  possible  grades  may  be  inherited, 
and  whereas  it  is  very  probable  that  there  is  a  correlation  disturbance  in 
the  relationship  of  the  upper  to  the  lower  jaw  which  may  involve  aU  di- 
mensions, we  must,  in  the  treatment  of  those  anomalies,  resort  to  extrac- 
tion, and  we  must  also  consider  as  biologically  incorrect  the  standpoint 
of  Angle's  school,  viz.,  that  in  the  restoration  of  normal  occlusion  and 
normal  facial  relation's,  extraction  is  at  all  times  unnecessary. 


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AN  EPITOMB  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    253 

PUBLIC  DENTAL  SERVICE 
By  Walter  Harrison,  L.D.S.,  Eng.,  D.M.D.  Harv.,  Brighton,  Eng. 

The  movement  of  public  dental  service  must  be  national,  in  the  sense 
that  those  who  are  eligible  for  treatment,  even  in  remote  villages,  should 
be  able  to  avail  themselves  of  the  privileges. 

The  fundamental  principles  in  a  public  dental  service  should  be: 

1.  The  service  should  be  entirely  controlled  by  the  profession. 

2.  Every  reputable  registered  dentist  in  the  district  should  have  the 
option  of  joining  the  staff. 

3.  The  profession  (by  means  of  a  committee)  should  decide  who  are 
suitable  persons  to  receive  the  benefit.    • 

4.  The  fees  should  be  fixed  by  the  local  practitioners. 

THE  FIRST   ''public  DENTAL  SERVICE." 

The  "Brighton  and  District  Public  Dental  Service"  is  formed  to 
check  "the  admitted  evils  of  excessive  medical  charity  and  misuse  of 
hospitals,"  and  enable  certain  sections  of  the  community,  who  are  unable 
to  pay  the  ordinary  fees,  to  obtain  dental  attention  by  registered  dentists, 
at  modified  fees,  and  by  a  system  of  payment  by  instalments,  through 
the  means  of  an  organization  under  the  control  of  the  local  members  of 
the  profession. 

[The  Dental  Review,  March,  1916] 

Original  Communications 

What  IS  the  Matter  with  Dentistry  in  St.  Louis?    By  Clarence  O.  Simpson. 

President's  Address.     By  E.  A.  Boyce. 

Some  Recent  Tendencies  in  Practice.    By  Arthur  G.  Smith. 

Three  Years  and  Some  More.    By  Franklin  B.  Clemmer. 

Chemical  Treatment  for  Pyorrhea  Alveolaris-Necrotic  Tissue.     By  J.  S.  Bridges. 

Proceedings  of  Societies 

Chicago  Dental  Society. 

St.  Louis  Dental  Society,  October  12,  191 5. 

Editorial 
Dental  Service  in  the  Public  Schools  of  Chicago. 

[The  Dental  Summary,  March,  1916I 
Regular  Contributions 

The  Place  of  the  Silicates  in  Dentistry.    By  Charles  C.  Voelker. 

A  One  Tooth  Bridge.    By  D.  D.  Smith. 

Root  Resection  and  Apical  Canal  Filling  After  Resection.    By  Carl  D.  Lucas. 

A  New  Retainer  for  Pyorrhetic  Tooth.     By  Alden  J.  Bush. 

Some  Problems  in  Mounting  Artificial  Dentures.    By  George  H.  Wilson. 

The  Anatomy  of  the  Oral  Cavity  in  its  Relation  to  Local  Anesthesia.    By  Hugh  W.  Mac- 

MiUan. 
President's  Address.    By  Edward  C.  Mills. 


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254  THB  DENTAL  DIGEST 

*Soine  of  the  Cases  Dental  Surgeons  Treat  in  the  European  War.    By  A.  M.  Fauntkroy. 

Historical  Sketches  and  a  Few  Items  m  Practice.    By  J.  G.  Templeton. 
♦The  Oral  Prophylaxis  Treatment  vs.  "Cleaning  Teeth."    By  Gillette  Hayden. 

A  Sand  Sterilizer.    By  C.  S.  Starkweather. 

SOME  OF  THE  CASES  DENTAL  SURGEONS  TREAT  IN  THE  EUROPEAN  WAR* 
By  Surgeon  A.  M.  Fauntleroy,  U.  S.  N.,  WashiKgton,  D.  C. 

"One  of  the  most  striking  features  of  the  value;  of  a  dentist  in  the  or- 
ganization of  a  military  hospital  is  shown  in  the  results  obtained  by  sur- 
gical cooperation  with  the  dentists  at  the  American  ambulance  in  con- 
nection with  the  mutilating  wounds  of  the  face  (Illustrated).  These 
wounded  always  show  compound  fractures  of  the  upper  or  lower  jaw, 
with  a  variable  amount  of  loss  of  substance.  They  represent  a  class  of 
cases  which  extends  over  a  period  of  months  before  a  final  operation  is 
performed  which  completes  the  result.  A  wound  of  this  character  is 
considerably  hampered  at  first  with  reference  to  the  healing  process  on 
account  of  the  secretions  from  the  mouth  and  the  necessary  feeding  of 
the  patient.  At  the  first  operation  these  ragged  and  mutilating  wounds 
are  treated  by  the  careful  trinmiing  away  with  scissors  of  the  sloughing 
areas.  In  this  procedure  the  vermilion  border  of  the  lip  is  preserved  as 
much  as  possible,  and  then  the  tissues  are  loosely  brought  together  with 
sutures  and  protected  by  a  loose  dressing,  which  has  to  be  changed  sev- 
eral times  a  day. 

The  preliminary  steps  of  the  operation  consist  of  shaving  the  face  and 
neck,  scrubbing  with  green  soap  and  water,  followed  by  70  per  cent, 
alcohol.  As  the  mouth  secretions  are  profuse  and  the  bleeding  rather 
free,  it  will  be  necessary  to  provide  means  for  the  prompt  removal  of  this 
mixed  fluid  from  the  pharynx  during  the  operation  in  oi*der  not  only  to 
prevent  strangulation  but  also  the  inhalation  of  septic  material  which 
may  cause  pneumonia.  This  is  best  accomplished  by  a  simple  water- 
suction  apparatus  secured  to  a  faucet  in  the  operating  room  and  having  a 
long  tube  attached  which  ends  in  a  good  sized  catheter.  This  latter  is 
held  in  the  pharynx  by  an  assistant  during  the  operation,  and  the  fluid  is 
thus  removed  as  it  accumulates. 

The  most  that  is  hoped  for  from  the  first  operation  is  that  the  soft 
parts  will  unite  in  such  a  way  as  to  admit  of  correcting  any  serious  de- 
formity later  on  by  means  of  a  final  plastic  operation.  There  are  usually 
three  stages  in  the  general  operative  procedure.    The  first  stage  consists  of 

*To  give  our  readers  something  of  an  idea  of  some  of  the  face  and  jaw  wounds  that  the 
army  dental  surgeon,  in  the  European  war,  has  to  treat,  we  copy  this  description  from  the 
'  *  Report  on  the  Medico-Military  aspects  of  the  European  War,"  by  Surgeon  A.  M.  Fauntleroy, 
U.  S.  N.,  which  has  just  been  published. — Editor. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    255 

bringing  the  soft  parts  loosely  together,  as  indicated  above.  Usually 
there  is  so  much  loss  of  bony  substance  that  no  effort  can  be  made  at  this 
time  to  unite  the  fractured  ends  of  the  bone. 

After  the  soft  parts  have  united,  the  second  or  dental  stage  is  begun. 
A  metal  bridge  is  anchored,  by  the  dentist,  on  whatever  teeth  remain  at 
the  ends  of  the  fragments.  This  bridge  may  be  temporary  at  first  for  the 
purpose  of  simply  holding  the  loose  fragments  in  a  steady  position  in  the 
mouth.  Gradually  a  scar  will  form  over  the  ends  of  these  fragments  and 
the  continuity  of  the  mucous  membrane  of  the  mouth  is  slowly  restored 
over  the  scar  thus  formed.  The  condition  of  the  parts  at  this  time  is 
fairly  satisfactory  although  there  may  be  considerable  puckering  as  a 
result  of  the  partial  or  complete  healing  of,  the  original  wound.  Once 
the  mucous  membrane  has  grown  over  the  scar  between  the  bone  frag- 
ments the  third  stage  of  the  operation  may  be  attempted.  This  consists, 
first,  of  a  plastic  procedure,  which  is  directed  toward  as  complete  a  res- 
toration of  the  face  as  is  compatible  with  the  destructive  effects  of  the 
original  wound  and  the  available  skin  in  the  immediate  neighborhood  of 
the  scars.  The  second  step  consists  in  the  removal  of  a  portion  of  a  rib, 
or  of  the  tibia,  which  is  then  transplanted  to  complete  the  bony  continuity 
of  the  jaw  beneath  the  bridge. 

In  proceeding  with  the  plastic  op)eration  on  the  skin,  it  may  be  neces- 
sary to  partially  remove  the  scar  so  as  to  bring  about  a  better  readjustment 
of  the  tissues.  Injury  to  the  newly  formed  mucous  membrane  must  be 
carefully  avoided,  but  if  it  is  necessary  to  incise  it,  or  if  accidentally 
wounded,  it  must  be  carefully  sutured.  Having  outlined  the  plastic 
work  by  the  formation  of  suitable  skin  flaps,  the  ends  of  the  bony  frag- 
ments are  carefully  dissected  free  from  the  scar  tissue  so  that  no  injury 
results  to  the  underlying  mucous  membrane.  The  ends  of  these  frag- 
ments are  now  freshened  by  either  beveling  or  grooving.  An  accurate 
estimate  is  then  made  of  the  bone  required  to  bridge  the  gap  and  a  suit- 
able piece  of  rib  with  periosteum  may  be  resected,  or  a  portion  of  the  tibia 
with  its  periosteum  may  be  removed,  according  to  the  preference  of  the 
operator. 

There  are  several  ways  of  securing  the  transplanted  bone  in  place. 
It  may  be  beveled  and  fitted  into  corresponding  grooves  at  the  ends  of  the 
fragments;  it  may  be  drilled  and  sutured  in  position  with  chromic  gut;  or, 
if  the  conditions  are  favorable,  some  form  of  bony  inset  may  be  attempted 
along  the  lines  of  a  mortise  and  tenon  joint.  Having  fixed  the  bone  in 
place,  the  skin  flaps  are  sutured  and  boric  acid  dusted  over  the  suture 
lines.  The  after-treatment  consists  of  careful  liquid  feeding  and  frequent 
mouth  washing. 


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256  THE  DENTAL  DIGEST 

THE  ORAL  PROPHYLAXIS  TREATMENT  VS.  "CLEANING  TEETH" 
By  Gillette  Hayden,  D.D.S.,  Columbus,  Ohio 

The  advantages  of  the  oral  prophylaxis  treatment  over  the  usual 
process  of  cleaning  teeth  are: 

First:  The  treatment  given  is  definitely  aimed  at  the  elimination  from 
the  mouth  of  all  d6bris. 

Second:  The  tooth  surfaces  are  rendered  smooth  so  that  d6bris  will 
not  adhere  so  readily  to  them,  and  the  patient  therefore  can  more  accur- 
ately care  for  the  mouth  and  teeth. 

Third:  The  patient  is  stimulated  to  give  better  attention  to  the 
mouth  and  teeth  because  of  the  frequent  treatment  at  the  hands  of  the 
dentist. 

Fourth:  If  any  cavity  development  occurs,  or  any  dental  operation 
becomes  faulty,  or  any  adverse  condition  of  the  mouth  develops,  the  den- 
tist has  an  opportunity  to  discover  such  a  condition  in  its  early  stages. 

Fifth:  The  teeth  and  their  investing  tissues  are  maintained  in  such  a 
state  of  health  that  their  resistance  to  disease  will  be  normally  high. 
Thus  to  a  great  degree  decay  of  the  teeth  and  loss  of  their  investing  tissues 
through  disease  are  prevented,  as  are  also  those  systemic  diseases  which 
result  from  mouth  infection. 

[The  Dental  Outlook,  March,  1916] 
Original  Communications 

The  Present  Status  of  Oral  Sepsis,  Its  Relation  to  Systemic  Disease — J.  Grossman,  M.D. 

Discussion  of  Dr.  Grossman's  Paper.    By  M.  Grossman,  M.D. 

A  Small  Inlay  Becomes  a  Large  Outlay.    By  L.  Eliasberg,  D.D.S. 

On  the  Admission  of  Dentists  to  Our  Societies — A  Reply  to  "Quality  and  Quantity." 

M.  H.  Feldman,  D.D.S. 
Concerning  the  Teeth. 

[The  Dental  Register] 
Contents 

Event  and  Comment. 

The  Shortage  of  Platinum. 

Efficiency  in  Tooth  Brushing. 

Fixed  Laws  Governing  Dental  Amalgams. 

Diagnostic  Methods  for  Anesthesia. 

The  Dentist  and  the  Orthodontist. 

Some  Refraction 

Some  Refractories  Used  in  Dentistry. 

Succinimid  of  Mercury. 

Indents. 

[The  Texas  Dental  Journal,  February,  19 16] 
Original  Communications 
The  Business  Side  of  Dentistry. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE    257 
With  Our  Contemporaries 

Malplaced  and  Impacted  Third  Molars. 

Pulpless  Teeth. 

Hilitary  Surgery. 

Cavity  Preparation. 

Dr.  Edward  Livingston  Trudeau. 

The  Educational  Value  of  Oral  Hygiene  in  the  Army. 

Advice  to  Those  About  to  Wear  Artificial  Teeth. 

[The  IfUernatianal  Journal  of  Orthodontia,  February,  1916] 

Original  Articles 

Students  as  Orthodontists.    By  Adelbert  Femald)  D.M.D.,  Boston,  Mass. 
Jurisprudence.    By  Elmer  D.  Brothers,  B.S.,  L.L.B.,  Chicago,  Ills. 
♦A  Plea  for  Conservation  of  the  Cementum.    By  F.  Hecker,  B.S.,  D.D.S.,  A.M.,  M.D. 
History  of  Orthodontia  (Continued).   By  Bemhard  W.  Weinberger,  D.D.S.,  New  York  City. 
Case  History.    By  H.  C.  Pollock,  D.D.S.,  St.  Louis,  Mo. 

A  PLEA  FOR  CONSERVATION  OF  THE  CEMENTUM 
By  F.  Hecker,  B.S.,  D.D.S.,  A.M.,  M.D. 
Director  of  Research  Laboratory  of  the  Dewey  School  of  Orthodontia,  Kansas  City,  Mo, 

The  object  of  this  paper  is  a  plea  for  less  heroic  instrumentation  and 
greater  conservation  of  the  cementum  on  the  roots  of  teeth  affected  by 
pyorrhea  alveolaris.  Wlien  a  failure  of  union  between  the  peridental 
membrane  and  the  root  of  the  tooth  occurs  after  heroic  instrumentation 
has  been  instituted,  it  is  not  because  the  peridental  membrane  has  been 
removed  in  its  entirety  for,  on  scaling  the  roots  of  the  teeth,  only  the 
ends  of  the  fibers  attached  to  the  cementum  have  been  cut  and  partially 
removed,  while  the  fibers  of  the  alveolar  surface  are  often  intact.  The 
failure  of  union  results  because  the  operator,  in  his  heroic  scaling,  has 
removed  the  basal  layer  of  the  cementum,  and  the  dentin  of  the  root  of 
the  tooth  is  exposed.  Even  if  a  few  islands  of  the  cementum  are  left  on 
the  root  of  the  tooth,  the  area  of  destruction  of  the  cementum  is  propor- 
tionately so  great  that  the  remaining  cementoblasts  (or  lacunae)  are  un- 
able to  regenerate  the  cementum  tp  such  an  extent  as  to  replace  the 
destroyed  cementum. 

The  popular  teaching  at  the  present  is  that  the  peridental  membrane 
carries  in  its  substance  the  cementoblasts  and  that  the  development  of  the 
cementum  is  dependent  on  the  peridental  membrane.  This  teaching  the 
author  believes  is  not  correct,  for  the  reason  that  the  peridental  mem- 
brane histologically  is  an  exact  counterpart  of  the  periosteum.  One 
needs  to  do  nothing  more  than  examine  a  slide  made  from  a  section  which 
shows  the  root  of  the  tooth  in  situ  in  the  alveolus  to  be  convinced  that 
such  is  the  case.  And  further,  the  author  believes  it  is  impossible  fqr  one 
to  place  the  pointer  of  the  eye-piece  at  a  definite  point,  and  state  that  the 
tissue  at  one  point  is  peridental  membrane,  while  that  at  an  adjoining 


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258  THB  DBNTAL  DIGBST 

point  it  is  periosteum,  for  histologically  there  is  no  evidence  on  which  one 
can  make  an  actual  diflferentiation.     In  lieu  of  the  work  done  by  Mac- 
Ewen  of  Scotland,  in  which  he  shows,  by  experimental  evidence,  that 
the  periosteum  does  not  carry  osteoblasts  in  its  substance,  and  further 
that  the  function  of  the  periosteum  relative  to  the  formation  of  new  bone 
is  that  of  a  limiting  membrane;  the  author,  in  his  examination  of  a  large 
number  of  slides  of  sections  which  he  has  made  of  the  root  of  the  tooth  in 
the  alveolus  taken  from  the  human  mouth  in  the  morgue,  has  not,  up  to 
the  present,  observed  any  free  cells  in  the  substance  of  the  peridental 
membrane  in  the  vicinity  of  the  cementum,  which  morphologically  re- 
sembles the  cementoblasts  described  by  Black  and  Noyes.    The  periden- 
tal membrane,  the  author  believes,  is  a  limiting  membrane  for  the  cemen- 
tum and  the  alveolus.    Vitally,  the  fibers  of  the  peridental  membrane 
have  a  direct  affinity  for  the  cementum  and  if  the  cementum  is  absent  the 
fibers  do  not  find  a  surface  which  is  adapted  to  their  need,  and  no  union 
occurs. 

[Dominion  Denial  Journal,  February,  1916] 

Original  Communicalions 

Anocain.    By  E.  W.  Paul,  D.D.S.,  L.D.S.,  Toronto. 

The  Advantages  and  Risks  of  Combined  Local  and  General  Anaesthesia.     By  W.  H.  B. 

Aikins,  M.D.,  Toronto. 
The  Combined  Use  of  Local  and  General  Anaesthetics  and  the  use  of  Adrenalin.     By  Dr. 

D.  J.  Gibb  Wishart,  Toronto. 
Mr.  Barker's  Method  of  Spinal  Anaesthesia.     By  C.  H.  Hair. 
Gas  and  Oxygen  Analgesia.    By  Dr.  H.  R.  Holme,  Toronto. 
Ether.    By  Dr.  J.  F.  L.  Killoran,  Toronto. 

*The  Methods  of  Resuscitation  in  Anaesthesia.    By  Dr.  T.  R.  Hanley,  Toronto. 
Anaesthetics.    By  E.  W.  Paul,  D.D.S.,  L.D.S.,  Toronto. 
It  Pays  to  Care  for  the  Soldiers'  Teeth.    By  Lieut.-Col.  Hendrie. 

THE  METHODS  OF  RESUSCITATION  IN  ANAESTHESIA 
Dr.  T.  R.  Hanley,  Toronto 

The  methods  of  resuscitation  have  been  interpreted  by  me  to  mean 
the  treatment  of  the  dangers  which  arise  during  anaesthesia  as  well  as  the 
actual  treatment  of  suspended  animation. 

I  intend  to  bring  to  your  notice  some  of  the  commoner  dangers  arising 
during  anaesthesia  and  follow  them  up  by  suggestions  which  have  proven 
in  my  experience  to  be  most  beneficial. 

Broadly  speaking,  then,  the  dangers  met  with  in  anaesthesia  may  be 
divided  into  two  groups: 

(i)  Respiratory  failure. 

(2)  Cardiac  failure. 
The  Causes  of  Respiratory  Failure — 

I.  Blocking  of  the  air  passages  by  foreign  materials,  such  as  blood, 
vomitus,  mucus,  etc. 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE      259 

Treatment — must  be  preventive — 

(a)  Always  ask  the  patient  before  beginning  your  anaesthetic  about 
the  presence  of  artificial  teeth. 

During  the  introduction  try  and  prevent  vomiting.  If  the  patient 
does  vomit,  turn  his  head  to  one  side  and  tile  the  shoulder;  if  necessary. 
lower  the  head  of  the  table. 

(b)  Mucus. — If  it  is  anticipated  for  any  reason,  such  as  bronchitis, 
tuberculosis,  give  atropine  gr.  i  /  loo  half  an  hour  before  operation.  If 
the  patient  does  develop  mucus  and  the  accompanying  cyanosis  tends  to 
become  alarming,  give  the  patient  more  air  or  oxygen,  and  use  more 
anaesthetic  proportionately.  If  the  patient  stops  breathing  use  Shafer's 
method  of  resuscitation. 

(c)  Blood, — Try  to  get  it  to  drain  out  by  placing  the  head  well  over 
to  the  side.  Put  a  piece  of  gauze  in  the  corner  of  the  mouth.  In  mouth 
operations  use  Johnston's  apparatus  and  pack  the  throat.  In  nose 
operations,  such  as  radical  antrum,  place  a  plug  in  the  posterior  naso- 
pharynx. 

(d)  Anatomical  Ahnormalities. — Spurs,  adenoids,  goitre,  etc. 

(e)  Spasm  of  the  muscles  at  the  base  of  the  tongue.  Spasms  of  the 
aryteno-epiglottidean  folds  in  the  larynx  and  general  spasm  of  the  respira- 
tory muscles. 

See  that  the  head  is  in  the  best  possible  position  for  free  breathing.  Let 
them  assume  the  natural  position  in  which  they  sleep.  Some  patients  are 
roimd  shouldered  and  breathe  better  with  a  pillow  under  the  head.  In 
some  cases  it  is  well  to  place  the  nasal  tube  in  position  reaching  as  far  as 
the  upper  border  of  the  epiglottis.  Sometimes,  holding  the  jaw  forward 
from  behind  the  angle  so  that  the  tongue  muscles  are  on  the  stretch,  tends 
to  raise  the  base  of  the  tongue  from  the  posterior  pharyngeal  wall — and 
will  suffice.  As  a  last  resort,  use  the  mouth  gag  and  pull  the  tongue  for- 
ward with  a  pair  of  forceps. 

If  spasm  of  the  muscles  of  the  lamyx  is  due  to  a  flake  of  mucus,  which 
is  sometimes  the, case,  let  the  patient  have  a  few  breaths  of  air  and  do  not 
push  the  anaesthetic.  If  due  to  irritation  from  strong  vapor,  give  more 
air  or  oxygen. 

(f)  Position  of  the  Patient, — ^Absolutely  prone  as  in  laminectomy, 
trephining,  cerebellar  tumor,  kidney  operations,  etc. ;  the  obvious  treat- 
ment is  to  inunediately  change  the  position. 

(g)  Toxic  action  of  the  anasthetic, 

1.  Early. — Relative  overdose. 

2.  Late. — Overdose  causing  a  paralysis  of  the  centre  in  the  medulla. 
In  either  case,  act  quickly — open  the  jaws,  pull  the  tongue  forward, 

sweep  the  fingers  around  the.  posterior  pharynx  and  see  that  no  foreign 


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260  THE  DENTAL  DIGEST 

matter  is  blocking  the  air  passages.  Try  artificial  respiration,  and  if  air 
is  entering  the  lungs  no  further  anxiety  may  be  felt  on  that  point.  If  air 
does  not  enter,  push  the  tongue  forward  from  the  base  by  placing  the 
forefinger  in  the  mouth  and  again  try  your  artificial  respiration.  If  that 
doesn't  help  matters,  tracheotomy  should  be  performed  and  artificial 
respiration  carried  on  for  at  least  one  hour,  providing  the  patient  has  not 
revived  in  the  meantime. 

At  the  same  time  as  you  are  using  Sylvester's  method  have  an  assistant 
use  rhythmical  tongue  traction  (Laborde). 

(h)  Where  shock  is  anticipated,  or  the  general  condition  of  the  pa- 
tient is  below  par,  it  is  well  to  start  interstitial  salines  at  the  beginning  of 
the  operation,  and  not  wait  until  the  patient  is  in  extremis. 

(i)  In  sudden  severe  haemorrhage,  stop  your  anaesthetic,  give  your 
salines  by  the  Aeedle  into  the  vein,  and  lower  the  head  of  the  table. 

(j)     Exophthalmic  operations,  mastoids  empyema,  erect  posture  for 
nose  and  throat  operations,  use  very  light  anaesthesia.    Do  not  abolish 
the  reflexes  completely. 
Cardiac  failure  may  be  due  to: 

1.  Extrinsic  causes  other  than  overdose. 

2.  Toxic  action  of  the  anaesthetic. 
Extrinsic  causes, 

(a)  Fright — at  the  very  beginning  of  the  anaesthetic — a  very  common 
cause,  you  will  remember,  in  pre-anaesthetic  days;  use  morphia  gr.  J- J 
before  the  operation.    Try  always  to  win  the  confidence  of  your  patient. 

(b)  Feeble  condition  of  the  patient  from  exhausting  diseases,  consti- 
tutional dyscrasia,  etc.  Proper  choice  of  anaesthetic,  care  in  the  adminis- 
tration and  proper  preparation  beforehand  will  obviate  these  to  some 
extent. 

(c)  Shock  from  operation,  such  as  a  re-section  of  bowels,  cutting  the 
spermatic  cord,  rectal  operations,  etc.  Reflex  of  threatened  vomiting, 
especially  with  chloroform,  and  position  of  the  patient  must  all  be  thought 
of  and  properly  met. 

Toxic  action  of  ancesthetic. 

1.  Syncope  in  the  early  stages,  more  especially  with  chloroform, 
owing  to  relative  overdose  or  cardiac  inhibition  caused  by  strong  vapor 
irritating  the  laryngeal  branches  of  the  vagus  nerve. 

2.  Later  syncope  from  overdose,  causing  paralysis  of  the  centre  in 
the  medulla  or  of  the  cardiac  muscle  and  its  intrinsic  ganglia. 

Treatment:  Lower  the  head  (invert  children),  open  the  mouth,  draw 
out  the  tongue,  and  while  you  do  Sylvester's  method  of  artificial  respira- 
tion have  an  assistant  do  rhythmical  tongue  traction  of  Laborde. 

Have  the  nurse  give  whatever  stimulants  you  may  think  necessary.    I 


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AN  EPITOME  OF^CURRENT  DENTAL  AND  MEDICAL  LITERATURE   261 

prefer  camphor  grs.  lo,  pituitary  extract  i  cc,  or  strychnia  gr.  ^  in  the 
order  named. 

If  the  abdomen  is  open,  have  the  surgeon  gently  massage  the  heart. 

Electrical  stimulus  to  the  side  of  the  neck  is  recommended  in  the  hope 
of  influencing  the  phrenic  nerve,  but  the  result  is  doubtful,  considering,  as 
we  must,  the  close  proximity  of  the  vagus. 

The  pulmotor,  lauded  so  greatly  a  few  years  ago,  has,  I  think,  been 
relegated  to  the  museum,  but  a  new  instrument  has  been  devised  which 
promises  good  results  and  will  bear  a  thorough  trial. 

Injection  of  strychnia  directly  into  the  heart  muscle  may  be  done  as  a 
last  resort,  but  I  don't  see  that  it  has  much  to  commend  it. 

[Oral  Health  J  February,  19 16] 

Contents 

Photograph,  Dr.  Thomas  L.  Gihner,  Chicago,  111. 
*Chronic  Oral  Infections  and  Their  Relation  to  Diseases  in  Other  Parts.    By  Thos.    L. 

Gihner,  M.D.,  D.D.S.,  Sc.D.,  Chicago. 
Resume  of  Discussion  of  Dr.  Gilmer's  Paper. 

Local  Anesthesia  With  Use  of  Anocain.    By  B.  R.  Gardiner,  D.D.S.,  Toronto. 
Impressions  of  the  Twenty- third  Annual  Meeting  of  American  Institute  of  Dental  Teachers. 

By  Thomas  Cowling,  D.D.S.,  Toronto. 
Address  Delivered  to  Toronto  Dentists  by  Major  Clayton,  Acting  Chief  Dental  Surgeon, 

Canadian  Army  Dental  Corps. 
Great  Need  for  Reading  Matter  at  the  Front. 

Splint  for  Fractured  Mandible.    By  William  Heqidon  Pearson,  D.D.S.,  Norfolk.  Va. 
Chicago  Dental  Society's  Fifty-second  Meeting.    By  W.  B.  Amy,  D J).S.,  Toronto. 

CHRONIC  ORAL  INFECTIONS  AND  THEIR  RELATION  TO 

DISEASES  IN  OTHER  PARTS 

By  Thomas  L.  Gilmer,  M.D.,  D.D.S.,  Sc.D. 

The  preliminary  report  made  by  Dr.  A.  M.  Moody,  bacteriologist,  St. 
Luke's  Hospital.  This  study  is  for  the  purpose  of  determining,  so  far  as 
possible,  the  effect  on  animals  injected  with  strains  of  freshly  isolated 
streptococci  from  chronic  alveolar  abscesses.  In  this  work  strains  of 
streptococcus  viridans,  isolated  from  alveolar  abscesses  in  fifteen  patients 
suffering  from  various  pathological  conditions,  have  been  injected  into  a 
total  of  forty-seven  rabbits. 

The  streptococcus  viridans  in  every  instance  is  the  predominating 
organism,  and  that  in  only  one  instance  was  the  staphylococcus  found, 
and  then  just  an  occasional  colony  was  present. 

Of  the  fifteen  patients  with  chronic  alveolar  abscesses  six  had  also 
pyorrhea;  eight  had  rheumatism,  one  each  acute  gastric  ulcer,  neuritis, 
myocarditis,  mitral  endocarditis,  and  nephritis.  Rosenow's  technique, 
in  a  large  measure,  has  been  followed  in  these  studies.  The  exceptions 
are  two,  i.  e.  (i)  The  doses  of  streptococci  have,  in  all  instances,  been  less 
than  two  billion,  and  in  most  cases  between  one-half  and  one  billion. 


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262  THX  DSNTAL  DI0B8T 

These  are  approximate  numbers.     (2)  The  animals  have  been  allowed  to 
live  a  longer  time  after  injection. 

The  gross  pathological  lesions  present  in  the  forty-seven  rabbits  are 
given  below.  The  microscopical  examinations  of  these  have  not  as  yet 
been  completed,  but  in  so  far  as  these  observations  have  progressed,  the 
gross  diagnoses  have  been  confirmed.  Following  is  the  table  of  Rosenow 
in  the  animals  autopsied: 

Appendicitis  was  present  in 2% 

Hemorrhage  of  stomach 40% 

Ulcer  of  stomach 13% 

Ulcer  of  duodenum        2% 

Hemorrhage  or  pus  in  gall  bladder 13% 

Hemorrhage  in  pancreas 15% 

Hemorrhage  into  peritoneum 5% 

Arthritis  and  periostitis 40% 

Endocarditis   .....* 28% 

Pericarditis 5% 

Myocarditis 5% 

Nephritis 30% 

Hemorrhages  or  other  lesions  of  the  lungs 10% 

Hemorrhages  into  the  skin 2% 

Tongue 0% 

Eye 4% 

Hemorrhages  into  jaw 20% 

The  hemorrhages  into  the  jaw  have  not  been  previously  described, 
except  in  a  paper  on  experimental  scurvy  by  Jackson  and  Moody  before 
the  American  Association  of  Pathologists  and  Bacteriologists  in  St.  Louis, 
April,  1915.  These  hemorrhages  occur  beneath  the  periosteum  of  the 
lower  jaw  before  the  central  incisors.  Occasionally  they  occur  on  only 
one  side,  but  may  be  present  on  both. 

This  series  is  too  small  to  draw  any  definite  conclusions.  They, 
however,  indicate  a  certain  amount  of  selective  localization  for  the  strep- 
tococcus viridans  isolated  from  chronic  alveolar  abscesses.  To  be  more 
specific,  these  organisms  produced  gross  evidences  of  muscle  involvement 
in  60  pfer  cent.,  joint  and  bone,  aside  from  the  jaw,  in  40  per  cent.;  stom- 
ach in  40  per  cent.,  kidney  in  30  per  cent.,  and  jaw  in  20  per  cent.* 

We  occasionally  find  what  I  have  termed  atypical  alveolar  abscesses, 
the  lateral  abscess  of  black  on  the  sides  of  the  roots  of  teeth  having  live 
pulps. 

Black  believed  that  these  abscesses  were  due  to  acute  pyorrhea  alveo- 
laris  attacks,  the  infection  extending  from  the  gingival  border  root-wise 
through  a  narrow  channel  on  the  side  of  the  root. 

Since  Moody  and  I  have  found  in  20  per  cent,  of  our  cases  sub-perios- 
teal  hemorrhages  in  the  jaws,  I  am  inclined  to  believe  that  similar  hemor- 

*The  above  experimental  work  was  done  in  St.  Luke's  Hospital  Laboratory. 


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AN  BPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     2<»3 

rhages  may  be  found  in  the  peridental  membrane.  If  hemorrhages  are 
caused  by  the  streptococcus  in  the  periosteum,  may  it  not  cause  a  like 
condition  in  the  peridental  membrane  as  well? 

Since  the  area  involved  in  hemorrhage  may  later  become  abscessed, 
then  if  the  peridental  membrane  participates  in  like  hemorrhages  we  have 
a  seeming  scientific  solution  of  the  atypical  alveolar  abscess.  As  yet  we 
have  not  examined  the  peridental  membrane  for  hemorrhages,  but  intend 
to  look  for  them  in  this  organ. 

[New  York  Medical  Journal,  February  12,  19 16] 

EMETINE  IN  HEMOPTYSIS  IN  CHEST  WOUNDS 

J.  Dupont  and  J.  Troisier,  in  Btdletins  el  mlmoires  de  la  Socitti  midicale 
des  hSpiiaux  de  Paris,  November  27,  1914,  report  three  cases  of  pene- 
trating rifle  bullet  wounds  of  the  thorax  with  hemoptysis,  in  which  eme- 
tine was  used  with  results  apparently  as  satisfactory  as  those  already  re- 
ported by  several  observers  of  the  hemoptysis  of  pulmonary  tuberculosis. 
In  the  first  case,  with  a  wound  at  the  base  of  the  left  lung,  arterial  blood 
was  being  abundantly  expectorated  upon  admission,  and  the  man  was 
dyspnoeic  and  oppressed,  and  presented  signs  of  a  slight  hemothorax. 
The  condition  persisting  throughout  the  night  in  spite  of  the  dressing 
applied,  a  subcutaneous  injection  of  two  thirds  of  a  grain  (0.04  gram)  of 
emetine  hydrocholoride  was  given.  In  the  afternoon  the  bloody  expec- 
toration showed  marked  reduction,  and  in  the  succeeding  night  ceased 
almost  completely.  A  week  later,  the  patient  was  discharged  in  excellent 
condition.  In  a  second  similar  case,  a  single  injection  of  emetine  was 
also  followed  in  a  few  hours  by  cessation  of  bloody  expectoration.  In  the 
third  case,  that  of  a  man  wounded  a  week  before,  bloody  expectoration 
had  been  continuous,  and  auscultation  revealed  a  tendency  to  consolida- 
tion of  the  lower  portions  of  the  lungs,  with  crepitant  riles. 

A  MOUTH  WASH  IN  GRIPPE 
Dr.  Beverley  Robinson,  in  an  original  communication  on  the  Treat- 
ment of  grippe  in  this  issue  of  the  Journal,  page  293,  recommends  as  a 
mouth  wash  and  gargle  the  well  known  liquor  antisepticus  alkalinus. 
Doctor  Robinson  informs  us  that  even  more  efficacious  is  a  mixture  de- 
vised by  his  friend,  Dr.  Augustus  Wadsworth,  and  published  in  a  com- 
munication, Mcftith  Disinfection,  in  the  Prophylaxis  and  Treatment  of 
Pneumonia,  in  the  Journal  of  Infectious  Diseases  for  October,  1906,  page 
774.    The  formula  is  as  follows: 

]J    Sodium  chloride  (C.P.)        5ss; 

Sodium  bicarbonate  (C.  P.) gr.  x; 

Water  (dist.)        gij; 

Glycerin gj; 


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264  THE  DENTAL  DIGEST 

Alcohol       . Jv; 

Menthol    /  «*K^-J. 

Oil  of  wintergreen gtt.  iij; 

Oil  of  cinnamon gtt.  ij; 

Oil  of  eucalyptus gtt.  v; 

Tinct.  cudbear 5Jss; 

Tinct.  rhatany 5^- 

M.  Sig.:  Dilute  with  an  equal  volume  of  water. 

In  preparing-.this  solution,  remarks  Doctor  Wadsworth,  the  salts  should 
be  dissolved  in  the  water  before  adding  alcohol.  Even  when  carefully 
made  up,  a  cloudiness  or  precipitate  may  appear  in  the  solution,  on  ac- 
count of  the  presence  of  rhatany.  By  adding  two  or  three  of  the  flavoring 
oils  a  less  pronounced  taste  is  obtained  than  when  only  one  is  used. 

[New  York  Medical  Journal^  March  4,  191 6] 

RECOVERY  OF  STREPTOCOCCUS  VIRIDANS  FROM  NEW  YORK  STREET  DUST 

By  William  C.  Thuo,  M.D.,  New  York 

{From  the  Departmeni  of  Clinical  Pathology,  Cornell  Medical  College,  New  York.) 

In  view  of  the  almost  universal  presence  of  Streptococcus  viridans  in 
infections  of  the  wral  cavity  and  of  the  respiratory  tract — note  the  work 
of  Hastings,  Cecil,  and  others  and  its  almost  constant  presence  on  the  tips 
of  the  roots  of  teeth  extracted  from  patients  with  chronic  infectious  arthri- 
tis, the  recovery  of  this  particular  microorganism  from  the  out  of  door  dust 
seems  a  matter  worthy  of  investigation.  While  we  believe  that  such  in- 
fections are  transmitted,  in  the  great  majority  of  cases,  from  person  to 
person  by  contact,  sneezing,  and  expectoration,  still  it  seems  to  be  within 
the  range  of  possibility  that  the  streptococcus  may  be  spread  by  the  dust. 
That  this  dust  is  inhaled  in  large  amounts  no  one  will  deny. 

The  true  Streptococcus  viridans  has  been  recovered  from  dust  collected 
from  a  balcony  twenty  feet  above  the  street  level,  and  some  of  the 
strains  are  pathogenic  for  rats.  It  is  possible,  too,  that  this  streptococcus 
may  come  from  the  dried  feces  of  domestic  animals,  particularly  the  horse, 
since  some  of  the  strains  fermr.nt  some  of  the  same  carbohydrate  as  Strep- 
toccocus  equinus  does,  for  example. 

[Journal  American  Medical  Association,  February  12, 1916] 

THIONIN  as  a  diagnostic  stain  in  PYORRHEA  ALVEOLARIS 
Martin  Dupray,  B.S.,  M.S.,  Columbia,  Mo. 

I  have  seen  no  mention  in  the  literature  on  endamebas  in  pyorrhea 
alveolaris  of  the  use  of  thionin  as  a  diagnostic  stain  for  the  endameba. 
In  the  past  fifteen  months  while  doing  microscopic  work  for  several  den- 
tists in  this  city,  it  has  been  my  privilege  to  examine  a  large  number  of 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     265 

slides  of  alveolar  exudate  for  endamebas  and  other  organisms.  Most  of 
the  preparations  were  stained  before  being  examined,  and  the  stain  used 
in  the  majority  of  cases  was  thionin.  The  stain  was  prepared  according 
to  the  following  formula: 

Thionin 0.5  gm. 

Distilled  water loo.oc.c. 

Phenol  (carbolic  acid)  crystals 2.0  gm. 

This  solution  must  be  prepared  fresh  every  three  or  four  months. 

To  prepare  the  slide,  a  smear  is  made  of  the  exudate  as  with  other  pus 
and  dried  in  the  air.  The  smear  is  then  fixed  in  the  flame  and  stained  a 
few  seconds  while  still  warm  with  the  thionin  solution.  The  stain  is 
washed  off  with  water  and  the  slide  dried.  It  may  be  mounted  in  balsam 
with  a  cover  glass,  or  examined  direct  in  immersion  oil  as  desired.  The 
endamebas  are  stained  quite  distinctly  by  this  method.  The  cytoplasm 
is  stained  a  Ught  purplish  violet  and  the  nuclei  a  deeper  reddish  violet. 
Ingested  blood  corpuscles  and  other  material  undergoing  digestion  in  the 
body  of  the  organism  are  stained  nearly  black.  The  pus  cells  in  the  smear 
are  stained  a  light  blue,  with  their  nuclei  a  deeper  blue.  Bacteria  are 
also  well  stained,  the  fusiform  bacilli  and  spirillas  being  especially  plain. 
The  endamebas  stand  out  quite  distinctly  in  the  smear,  and  are  easily 
recognized.  A  person  accustomed  to  the  use  of  the  microscope  can  usually 
see  them  easily  with  the  low  power  (two- thirds  or  16  mm.)  objective,  using 
the  high  power  only  for  verification;  hence  a  considerable  area  of  the  smear 
can  be  covered  in  a  short  time. 

I  have  found  the  stained  preparations  much  more  reliable  than  un- 
stained preparations,  and  much  quicker,  on  account  of  the  time  con- 
sumed in  examining  an  unstained  slide.  Thionin  has  also  given  more 
uniform  results  than  the  double  staining  method  with  fuchsin  and  methy- 
lene blue,  and  the  stain  is  made  more  quickly  and  easily. 

This  stain  does  not  give  good  histologic  pictures  of  the  endamebas  and 
is  recommended  only  as  a  diagnostic  stain,  for  which  purpose  it  gives  very 
plain  pictures  of  both  the  endamebas  and  the  bacteria. 

[Journal  American  Medical  Association ^  February  19,  1916] 
THE  TOXITY  OF  ARSENOUS  AND  ARSENIC  ACID 

Compounds  of  arsenic  are  becoming  so  prominent  in  therapy,  and  the 
t3T>es  of  arsenic  products  for  use  in  medicine  have  become  so  diverse,  that 
any  information  bearing  on  their  possible  mode  of  action  should  be  wel- 
come. The  familiar  derivative  of  arsenic  which  early  found  its  way  into 
use  both  as  a  drug  and  as  a  poison  is  the  white  arsenous  oxid,  often  itself 
spoken  of  simply  as  arsenic.  The  salts  of  arsenous  add  are  also  employed, 
as  in  Fowler's  solution.    Arsenic  action  is  not  due  to  the  element,  but  to 


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2M  THB  DBNTAL  DIGEST 

the  ion  of  arsenous  acid,  HjAsO,.  Organic  arsenic  compounds  in  which 
the  metallic  atom  is  attached  directly  to  carbon  are  only  feebly  toxic. 
In  the  course  of  time,  within  the  body  they  seem  to  yield  more  or  less 
arsenous  acid,  a  reaction  which  may  suffice  to  explain  any  pharmacologic 
potency  possessed  by  the  organic  derivatives.  It  is  a  somewhat  unex- 
pected fact  that  the  closely  related  arsenic  acid  H3ASO4,  its  anhydrid 
and  its  salts  are  far  less  poisonous  than  is  arsenous  add.  This  statement 
has  now  and  then  been  disputed,  but  only  recently  again  substantiated 
at  the  pharmacologic  institute  of  the  University  of  Berlin  by  Joachimo- 
glu.  The  relatively  greater  toxicity  of  arsenous  in  comparison  with 
arsenic  acid  could  be  demonstrated  by  the  proportion  of  10:6  in  the  case 
of  the  lethal  dose  required  for  intravenous  injection  in  animals.  Perfusion 
experiments  with  isolated  frogs'  hearts  indicated  the  arsenous  compounds 
to  be  300  times  as  harmful  as  those  of  arsenic  acid.  In  the  case  of  the 
isolated  intestine  the  contrast,  though  plain,  was  not  equally  striking. 
This  has  raised  the  question  why  there  should  be  a  marked  disproportion 
in  the  relative  toxicity  of  comparable  quantities  of  arsenic  and  arsenous 
acids,  depending  on  the  mode  in  which  the  test  is  made.  The  explanation 
proposed  is  as  follows:  The  toxicity  of  the  arsenic  add  depends  on  the 
reducing  power  of  the  tissues  with  which  it  comes  into  contact.  By  this 
means  it  is  converted  into  the  very  poisonous  arsenous  compound.  Some 
individual  organs  or  tissues  have  comparatively  slight  reducing  potency. 
In  the  isolated  heart,  for  example,  arsenic  acid  exhibits  little  toxidty. 
Throughout  the  living  organism  as  a  whole  the  reduction  of  arsenic  add 
appears  to  be  far  more  readily  accomplished;  hence,  after  intravenous 
administration  of  the  ordinarily  less  nocuous  derivative,  it  may  become 
more  toxic  so  promptly  by  conversion  to  arsenous  acid  that  the  real  diflfer- 
ence  between  these  related  arsenic  derivatives  is  no  longer  conspicuous. 
This  may  also  explain  some  of  the  uncertainty  or  confusion  which  has 
existed  in  the  past  in  respect  to  the  comparative  action  of  the  two  sub- 
stances. 

[Journal  American  Medical  Association,  February  19,  1916] 

(Afnerican  Journal  Medical  Sciences) 
TONSILLAR  ENDAMEBIASIS  AND  THYROID  DISTURBANCES 

Tonsillar  lesions  of  an  infective  cryptic  character  were  found  by  the 
authors  in  22.8  per  cent.;  and  nasal  together  with  tonsillar  lesions  existed 
in  90  per  cent,  of  362  goitrous  individuals  examined  from  this  standpoint. 
In  typically  diseased  tonsils,  out  of  thirty-four  cases  examined  micro- 
scopically, 97  per  cent,  were  found  to  harbor  Endanueba  gingivcUis  (gros) 
in  the  tonsillar  crypts.  Of  sixteen  individuals  of  this  group  who  after 
treatment  by  means  of  emetine  hydrochlorid  were  reexamined,  thirteen,  or 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     267 

8 1  per  cent.,  were  shown  no  longer  to  have  eYidamebas  in  the  cryptal  con- 
tents. In  twenty-three  persons  to  whom  emetine  was  administered  a 
reduction  in  the  bulk  of  the  goitre  was  appreciable  in  eighteen;  and  of 
seven  dysthyroid  cases  included  in  this  group  of  those  treated,  six  were 
benefited  in  degrees  varying  from  slight  amelioration  to  apparent  cure. 

{Archiv  fiir  Kindnheilkunde,  Stuttgart^  November  2,  1915) 
mCH  ARCmNG  PALATE 

Landsberger  comments  on  the  disturbances  almost  inevitable  when 
the  palate  runs  up  abnormally  high.  The  nasal  passages  are  interfered 
with  by  it  and  mouth  breathing  is  inevitable.  It  also  entails  a  ten- 
dency to  a  vacuimi  in  the  nasopharynx  wl^ch  acts  injuriously  on  the  ear 
and  on  the  local  circulation.  The  spyace  inside  this  part  of  the  skull  is  also 
encroached  on  by  the  high  palate.  The  disturbances  from  the  latter  are 
often  ascribed  to  the  adenoids  frequently  found  with  it.  Another  serious 
trouble  from  it  is  the  resulting  abnormal  development  of  the  teeth.  The 
germinal  buds  do  not  develop  centrifugally,  as  in  normal  conditions,  but 
straight  downward.  The  condition  can  be  remedied  by  straightening  the 
roof  of  the  mouth,  forcing  its  sides  apart  and  thus  bringing  the  concave 
palate  down  to  be  more  nearly  flat.  He  gives  illustrations  of  a  spring 
and  screw  apparatus  for  the  purpose.  It  is  worn  between  the  teeth,  forc- 
ing the  rows  apart.  It  does  not  interfere  with  speaking  or  eating,  and  an 
actor  wore  it  without  interfering  with  his  professional  work.  The  benefit 
in  children  was  almost  miraculous  in  some  cases.  Deafness  subsided,  as 
also  asthma  and  the  headaches  which  had  tormented  the  children  for 
years.  Abnormal  salivation  was  also  arrested,  and  a  tendency  to  coryza. 
tonsillitis  and  bronchitis,  while  the  general  growth  was  promoted.  All 
these  changes  are  readily  explained  by  the  differences  seen  in  the  roentgen- 
ograms taken  before  and  after  wearing  the  brace. 

[Journal  American  Medical  Association,  March  4,  1916] 
THE  INTERRJELATION  BETWEEN  SALIVARY  AND  GASTRIC  DIGESTION 

Physiologists  have  long  known  that  the  starch-digesting  enzyme  pre- 
sent in  the  saliva  of  man  is  destroyed  as  soon  as  it  is  exposed  to  even  small 
concentrations  of  **free"  hydrochloric  add,  or,  in  terms  of  modem  chemi- 
cal interpretation,  hydrogen  ions  present  in  the  stomach.  From  the 
standpoint  of  a  useful  performance  on  the  part  of  the  starch-digesting 
saliva,  the  ready  inhibition  of  its  effectiveness  as  a  digestive  agent  was 
somewhat  mystifying  when  it  was  first  discovered;  for  the  duration  of 
amylolytic  activity  appeared  to  be  restricted  essentially  to  the  very  brief 
period  during  which  the  foods  are  retained  in  the  mouth,  masticated  and 
swallowed.  Subsequently  it  was  ascertained  that  the  actual  sequence  of 
events  within  the  stomach  does  not  compel  an  immediate  mixing  of  the 


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268  THB  DENTAL  DIOBST 

entering  contents  with  the  gastric  juice  which  is  being  secreted.  The 
mass  that  is  swallowed  in  successive  portions  accumulates  at  first  in  the 
fundus  of  the  stomach;  and  since  in  the  absence  of  vigorous  muscular 
movements  in  that  region  the  contents  are  penetrated  with  great  difficulty 
by  the  gastric  secretion  which  is  continually  being  poured  out  by  the 
walls  of  the  stomach,  salivary  digestion  can  actually  proceed  for  a  con- 
siderable time  without  serious  interruption.  In  view  of  the  rapidity  with 
which  the  salivary  enzyme  can  convert  starch  into  soluble  sugar,  the  pre- 
liminary digestion  of  carbohydrates  can  therefore  usually  be  completed 
before  destruction  of  the  effective  agent  in  the  saliva  takes  place.  Dr. 
Maxwell  of  the  physiologic  laboratory  at  the  University  of  Melbourne, 
has  suggested  a  further  fimction  of  the  salivary  enzyme  which  he  believes 
to  be  of  importance  for  the  later  digestive  processes.  It  has  long  been 
known  that  many  substances  in  suspension  or  in  coUoidal  solution  have 
the  power  of  absorbing  enzymes,  thereby  inhibiting  their  activity.  Max- 
well has  found  experimentally  that  although  unboiled  starch  administered 
in  the  form  of  intact  grains  does  not  hinder  the  action  of  pepsin,  peptic 
digestion  may  be  delayed  in  the  presence  of  colloidal  starch  solutions 
through  absorption  of  the  proteolytic  enzyme.  The  time  interval  for  the 
peptic  digestion  may,  for  example,  be  increased  fourfold  in  the  presence 
of  a  2  per  cent,  starch  solution.  There  is  a  stage  in  the  progressive  di- 
gestive disruption  of  the  starch  molecule  at  which  the  capacity  of  absorp- 
tion of  pepsin  is  lost.  This  is  coincident  with  the  appearance  of  dextrins, 
even  before  sugars  are  formed.  In  accord  with  the  foregoing  it  is  actually 
found  that  cooked  farinaceous  foods — rice,  potato,  bread,  porridge,  etc. 
— all  hinder  peptic  digestion  if  they  are  not  first  subjected  to  the  salivary 
digestion.  The  inhibition  of  peptic  activity  by  carbohydrates  like  gum 
acacia  is  not  prevented  by  a  previous  contact  with  saliva  for  the  reason 
that  they  are  not  digested  by  it.  The  positive  feature  to  which  Maxwell 
has  drawn  attention  has  been  summarized  by  the  statement  that  the 
saliva  of  man,  by  virtue  of  its  enzyme  ptyalin  or  amylase,  plays  a  consid- 
erable part  in  aiding  gastric  digestion  by  hydrolyzing  colloidal  starch 
which  would  otherwise  absorb  pepsin. 

FACTS  ABOUT  THE  BEHAVIOR  OF  THYMOL  IN  THE  BODY 

In  connection  with  the  treatment  of  hookworm  disease  and  comparable 
forms  of  intestinal  infection  with  parasitic  invaders,  considerable  promi- 
nence has  been  given  to  the  use  of  thymol  (methylisopropylphenol),  a 
phenol  derivative  obtained  commercially  from  oil  of  ajowan  and  occurring 
in  oil  of  horsemint,  oil  of  thyme  and  some  other  volatile  oils.  Thymol  is 
an  antiseptic  comparable  in  many  ways  to  phenol  and  the  cresols,  but  it  is 
less  soluble  in  water,  and  for  this  reason  has  been  supposed  to  be  absorbed 


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AN  EPITOME  OF  CURRENT  DENTAL  AND  MEDICAL  LITERATURE     269 

with  greater  difficulty  from  the  alimentary  tract.  The  latter  assumption 
has  made  it  seem  more  valuable  as  an  antiseptic  for  use  in  the  gastro- 
intestinal tube  because  of  the  protection  from  direct  intoxication  by  the 
drug  thereby  afforded  to  the  organism  as  a  whole  while  the  parasite  is 
being  destroyed.  Owing  to  the  solubility  of  thymol  in  oils,  it  has  re- 
peatedly been  urged  that,  when  the  drug  is  U5td.  fatty  substances  should 
be  avoided  in  the  diet,  in  order  to  avert  nndue:abs^rption.of.thc.  l^r^e. 
doses  required  for  anthelmintic  effects.  One  nught  expect  th9,tXccttii- 
j)ound  with  these  prop)erties  wQuld  reappe^ar.  in  considerable  jqygyajities 
in  the  feces  after  its  administratioi^  byViral  paths.  Inwstiga?tions.jii  the 
Hygienic  Laboratory  of  the  U.  S.  Public  Health  Service  have  shown, 
however,  that  only  insignificant  amounts  of  ingested  thymol  are  excreted 
in  this  way.  This  would  indicate  that  thymol  is  almost  completely  ab- 
sorbed from  the  alimentary  tract  and  must  therefore  be  oxidized  in  the 
body  or  excreted  in  the  urine.  Seidell  has  therefore  directed  attention 
to  the  behavior  of  the  compound  after  absorption.  It  has  long  been 
known  that  absorbed  thymol  may  reappear  in  the  urine  as  a  glycuronate, 
just  as  other  alcoholic  derivatives  conjugate  with  glycuronic  acid  in  the 
metabolism.  A  careful  study  of  the  fate  of  thymol  gave  promise  of  dis- 
closing the  mechanism  of  its  action  on  hookworms,  and  consequently,  of 
indicating  the  path  to  be  followed  in  developing  drugs  of  greater  potency 
and  safety  than  thymol.  Even  now  it  is  being  urged  that  the  oil  of 
chenopodium  or  oil  of  American  wormseed  be  thus  employed.  The 
supply  of  thymol  is  said  to  be  extremely  limited  at  present,  and  the  oil  of 
chenopodium  is  regarded  as  generally  safer.  Seidell  has  found  that  less 
than  so  per  cent,  of  the  thymol  administered  either  to  experimental  ani- 
mals or  to  human  patients  who  received  the  thymol  treatment  for  hook- 
worms reappears  in  the  urine.  This  result,  in  connection  with  the  pre- 
viously mentioned  experiments  on  the  determination  of  thymol  in  the 
feces,  shows  that  of  the  thymol  administered,  from  one  half  to  two  thirds 
is  apparently  destroyed  or  fixed  in  the  body.  A  similar  fate  is  suggested 
for  compounds  of  related  type,  such  as  the  simpler  phenols.  No  satis- 
factory explanation  has  as  yet  been  found  for  this  apparent  disappearance 
of  administered  phenols.  With  respect  to  the  fraction  that  is  not  reex- 
creted  as  glycuronate,  it  has  been  surmised  that  it  may  be  temporarily 
fixed  by  the  tissues  or  eliminated  by  volatilization  with  the  expired  air. 
This  is  mere  conjecture  without  any  supporting  evidence.  From  a 
practical  standpoint  there  is  significance  in  Seidell's  finding  that  the  sim- 
ultaneous administration  of  olive  oil  with  thymol  apparently  caused 
very  slight  if  any  effect  on  the  percentage  of  excreted  drug.  In  his  opin- 
ion it  is  a  question,  therefore,  whether  oils  really  increase  the  amount  of 
absorption  or  only  the  rate. 


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270  TUB  DBKTAL  DIGEST 

[Medical  Record,  February  19,  1916] 

CHLORAMINE  IN  THE  TREATMENT  OF  WOUNDS  OF  THE  MOUTH  AND  JAWS 
A.  R.  Fisher  says  that  the  septic  character  of  all  gunshot  wounds  in- 
volving the  mouth  and  the  disadvantages  attending  the  use  of  the  com- 
mon antiseptics,  led.hioa.tot  try  chloramine  (toluene  sodium  sulphochlora- 
raide)  in  se^nfn.•*dL3es;  frxe!Ke|ngfcompound  fractures  of  the  jaw  and  two 
'..••:•  flesh  jwptmds  viyqiyiife3the.inojith..  A  two  ppr^^nt.  aqueous  solution  of 
•     •  ftn^agtotV^  vS^m  Icm  jrrigajbon;  jffi^&A  yf^t&mwi  out  every  hour  during 
the  ^^;&nrl:a8*ofCrn  as^  possible  ^ucui^liie  night.     Chloramine  besides 
being  V^Joi^firfiiVantiseptic^his  jtlfe  of  penetrating  the  tissues, 

and  is  not  so  readily  neutralized  by  albuminous  discharges  as  the  simpler 
chemical  antiseptics.  It  is  bland  and  non-irritant.  While  the  number 
of  cases  treated  was  small  the  results  were  most  encouraging. 

[Denial  Items  of  Interest,  March,  1916] 
Exclusive  ContrilnUions 

Antihygienic  Conditions  of  the  Oral  Cavity  and  Dental  Maladies,  May  Lead  Not  Only  to 
Tuberculous  Infection  but  to  Many  Other  Systemic  Maladies.    By  N.  L.  Castiglia,  D.D.S. 

The  Etiology  and  Treatment  of  Pyorrhea  Alveolaris.    By  G.  Chisohn,  D.D.S. 

Further  Facts  Regarding  Succinimide  of  Mercury  as  a  Cure  for  Pyorrhea.  By  Dr.  Georpc 
H.  Reed,  A.A.,  Dental  Surgeon,  U.S.N. 

Ther  Average  Dentist  and  Root  Canal  Work.    By  Samuel  Lang,  D.D.S. 

Orthodontia 

Dr.  Edward  H.  Angle's  Pin  and  Tube  Appliance.    By  A.  H.  Ketcham,  D.D.S. 

Prosthodontia 

Anatomical  Dentures.    By  Seimaro  Shimura,  D.D.S. 

Resiliency  as  Opposed  to  Rigidity  in  Artificial  Teeth.    By  R.  Morse  Withycombe. 

Society  Papers 
Therapeutic  and  Surgical  Treatment  of  Roots  and  the  Adjacent  Tissues.  By  J.  F.Biddle,  D.D.S. 
The  Restoration  of  Masticatory  Function  with  Carved  Gold  Inlays.    By  Rodrigues  Otto- 

lengui,  M.D.S.,  LL.D.,  D.D.S. 
An  Informal  Talk  on  Inlays.    By'Dr.  E.  S.  Tracy. 
Oral  Hygiene  and  Its  Relation  to  Better  Health  Conditions.    By  J.  P.  Delvin,  D.D.S. 

[British  Dental  Journal,  February  16,  1916] 
Original  Communications 

Valedictory  Address.    By  G.  Northcroft,  L.D.S.  Eng.,  D.D.S.  Mich. 

A  Case  of  Impetigo  Contagia  cured  by  the  Extraction  of  Septic  Teeth.    By  W.  Nicholson, 

L.R.C.P.,  M.R.C.S.,  L.D.S.  Eng. 
Alum  Wool.     By  J.  T.  Hall,  L.D.S.L 
Gestant  Composite  Odontomes.    A  Case  Reported  by  Mr.  A.  Barritt,  L.D.S.  Eng. 

Abstracts  and  Translations 

Mastication  and  Food  Utilization. 

Sterilizing  Dental  Instruments. 

Oxpara  for  Filling  Root  Canals. 

Case  of  Associated  Jaw  and  Lid  Movement.    By  Captain  A.  W.  Ormond,  F.R.C.S. 


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SOCIETY  NOTES  271 


SOCIETY  NOTES 

Alabama. 

The  next  meeting  of  the  Alabama  Dental  Association  will  be  held  at  Mobile,  Ala.,  April 
II,  1916. — ^J.  A.  Blue,  Binningham,  Ala.,  Secretary, 

Arizona. 

The  next  meeting  of  the  Arizona  Board  of  Dental  Examiners  will  be  held  in  Phoenix, 
Ariz.,  October  9-15,  1916. — Eugene  McGuire,  302  Noll  Bldg.,  Phoenix,  Secretary. 

Connecticut. 

The  Connecticut  State  Dental  Association  will  meet  in  New  London,  Conn.,  at  Hotel 
Griswold,  June  13-15,  1916. — Elwyn  R.  Bryant,  New  Haven,  Conn.,  Secretary. 

Florida. 

The  next  meeting  of  the  Florida  State  Dental  Society  will  take  place  at  Orlando,  Fla. 
June  21, 1916. — M.  C.  Izlar,  Ocala,  Fla.,  Secretary. 

Georgia. 

The  forty-seventh  annual  meeting  of  the  Geoi^gia  State  Dental  Association,  will  be  held 
at  Macon,  Ga.,  June  8-10,  1916,  beginning  at  11  a.m.  Thursday,  June  8th. — M.  M. 
Forbes,  803  Candler  Bldg.,  Atlanta,  Ga.,  Secretary. 

Idaho. 

The  next  meeting  of  the  Idaho  State  Dental  Society,  will  be  held  at  Boise,  June,  1916. — 
R.  J.  Cruse,  Pocatello,  Idaho,  Secretary, 

Illinois. 

The  Illinois  State  Dental  Society  will  hold  its  next  meeting  at  Springfield,  111.,  May  9-1 2» 
1916. — Henry  L.  Whipple,  Quincy,  111.,  Secretary. 

Indiana. 

The  fifty-eighth  annual  meeting  of  the  Indiana  State  Dental  Association  will  be  held  at 
the  Claypool  Hotel,  Indianapolis,  May  16-18,  1916. — A.  R.  Ross,  Lafayette,  Secretary. 

Iowa. 

The  next  meeting  of  the  Iowa  State  Dental  Society  will  take  place  at  Des  Moines,  Iowa, 
May  2-4. — H.  A.  Elmquist,  Des  Moines,  Iowa,  Chairman  of  Exhibit. 

Kentucky. 

The  Kentucky  State  Dental  Society,  will  hold  its  next  meeting  at  Louisville,  July  24, 
1916. — W.  T.  Farrar,  519  Starks  Bldg.  Louisville,  Ky.,  Secretary. 

The  next  meeting  of  the  National  Dental  Association  will  be  held  in  the  ist  Regiment 
Armory,  Louisville,  Ky.,  July  25-28,  1916. — Otto  U.  KiNG„Huntington,  Ind.,  Secretary. 

Massachusetts. 

The  next  meeting  of  the  Massachusetts  Dental  Society  will  be  held  in  Boston,  Mass., 
May  3-5,  1 916. — A.  H.  St.  C.  Chase,  Boston,  Mass.,  Secretary. 

Michigan. 

The  Michigan  State  Board  of  Dental  Examiners  will  meet  in  the  Dental  College  at  Ann 
Arbor,  June  19,  1916,  at  eight  o'clock  a.m.;  for  application  blanks  apply  to  E.  O. 
Gillespie,  Stephenson,  Mich.,  Secretary-Trecuurer. 

Mississippi. 
.   The  next  meeting  of  the  Mississippi  Dental  Association  will  be  held  at  Jackson,  Miss., 
May  1-3,  1916. — M.  B.  Varnado,  Osyka,  Miss.,  Secretary. 


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272  THE  DENTAL  DIGEST 

Nebraska. 

The  Nebraska  State  Dental  Society  will  hold  its  next  meeting  in  Lincoln,  Nebr.,  May 
16-18,  1916. — H.  E.  King,  Omaha,  Nebr.,  Secretary, 

New  York. 

The  Dental  Society  of  the  State  of  New  York  will  hold  its  next  meeting  at  the  Hotel 
Ten  Eyck,  Albany,  N.  Y.,  May  11-13,  1916.— A.  P.  Burkhart,  52  Genesee  St.,  Albany, 
N.  Y.,  Secretary. 

Pennsylvania. 

The  fifty-third  annual  meeting  of  the  Lake  Erie  Dental  .Association  will  be  held  at  Hotej 
Bartlett,  Cambridge  Springs,  Pa.,  May  iSr-jo,  1916 — ^J.  F.  Smith,  120  W.  i8th  St.,  Erie, 
Pa.,  Secretary. 

The  thirty-fifth  annual  meeting  of  the  Odontological  Society  of  Western  Pennsylvania 
will  be  held  at  the  Monongahela  House,  Pittsburgh,  Pa.,  Tuesday  and  Wednesday,  April 
II  and  12, 1916.— King  S.  Perry,  719  Jenkins  Bldg.,  Pittsburgh,  Pa.,  Secretary. 

The  next  regular  examination  of  the  Pennsylvania  Board  of  Dental  Examiners  will  be 
held  in  the  Musical  Fund  Hall  in  Philadelphia,  and  the  College  of  Pharmacy  Building 
in  Pittsburgh,  on  June  14-17,  19 16.  The  practical  work  vnW  be  held  at  the  Philadelphia 
Dental  College  in  Philadelphia,  and  the  University  of  Pittsburgh  in  Pittsburgh,  on  the 
first  day,  June  14th,  the  operative  work  being  held  at  eight- thirty  a.m.,  and  the  prosthetic 
work  at  one-thirty  p.m. — Alexander  H.  Reynolds,  4630  Chester  Ave.,  Philadelphia, 
Pa.,  Secretary. 

South  Carolina. 

The  forty-sixth  annual  meeting  of  the  South  Carolina  State  Dental  Association  will  be 
held  at  Chick's  Springs,  So.  Car.,  July  11-13,  1916. — Ernest  C.  Dye,  Greenville,  So. 
Car.,  Secretary. 

TlEXAS. 

The  Texas  State  Dental  Association  will  hold  its  next  meeting  at  Dallas,  Texas,  May 
9-12,  1916. — W.  O.  Talbot,  Fort  Worth,  Texas,  Secretary. 

Vermont. 

The  next  meeting  of  the  Vermont  Board  of  Dental  Examiners,  for  the  examination  of 
candidates  to  practise  in  Vermont,  will  be  held  at  the  State-house,  Montpelier,  June  26-28, 
191 6. — Harry  F.  Hamilton,  Newport,  Vt.,  Secretary. 

West  Virginia. 

The  next  meeting  of  the  West  Virginia  State  Dental  Association  will  be  held  at  the 
Kanawha  Hotel,  Charleston,  W.  Va.,  April  12-14,  1916. — J.  W.  Parsons,  Huntington, 
W.  Va.,  Secretary. 

Wisconsin. 

The  meeting  of  the  Wisconsin  State  Board  of  Dental  Examiners  will  be  held  at  the  Mar- 
quette Dental  College,  Cor.  9th  and  Wells  St.,  Milwaukee,  Wis.,  June  14, 1916,  commenc- 
ing at  nine  o'clock. — F.  A.  Tate,  Daniels  Blk.,  Rice  Lake,  Wis.,  Secretary. 

The  next  meeting  of  the  Wisconsin  State  Dental  Society  will  be  held  in  Wausau,  Wis., 
July  11-13,  1916. — ^Theo.  L.  Gilbertson,  Secretary. 


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FUTURE  EVENTS  273 


The  Louisiana  State  Dental  Society 

LAKE       /CHARLES 
OVES     V^IOMPANY 

The  Louisiana  State  Dental  Society  will  hold  their  annual  meeting  in  Lake  Charles,  one 
of  Louisiana's  most  picturesque  cities,  May  1-3,  191 6.  An  exceptionally  unique,  interesting 
and  instructive  program  has  been  arranged,  and  all  visiting  ethicAl  dentists  as  might  de 
sire  to  attend  are  cordially  invited. — ^J.  Crimen  Zeidler,  Suite  11 29  Maison  Blanche  Bldg., 
New  Orleans,  La.,  Secretary. 


FUTURE  EVENTS 


April  4-7,  1916. — Dental  Manufacturers'  Club,  Chicago,  111.    Meeting  in  the  Banquet  Hall, 

Auditorium  Hotel. — Chairman  Exhibit  Committee,  A.  C.  Clark,  Grand  Crossing,  Chicago, 
April  II,  1916. — Alabama  Dental  Association,  Mobile,  Ala. — J.   A.  Blue,   Birmingham, 

Ala.,  Secretary, 
April  11-12,  191 6. — Odontological  Society  of  Western  Pennsylvania,  Monongahela  House, 

Pittsburgh,  Pa. — King  S.  Perry,  719  Jenkins  Bldg.,  Pittsburgh,  Secretary. 
April  12-14,  19 1 6. — West  Virginia  State  Dental  Association,  Kanawha  Hotel,  Charleston, 

W.  Va.— J.  W.  Parsons,  Secretary. 
April  13-15,  1916. — Michigan  State  Dental  Society,  Detroit,  Michigan. — Clare  G.  Bates, 

Secretary. 
May  2-4, 191 6. — Iowa  State  Dental  Society,  Des  Moines,  la. — H.  A.  Elmql'ist,  Des  Moines, 

la.,  Chairman  of  Exhibit. 
May  3-5, 1916. — Massachusetts  Dental  Society,  Boston,  Mass. — A.  H.  St.  C.  Chase,  Boston, 

Mass.,  Secretary. 
May  8-10,  191 6. — Ontario  Dental  Society,  College  Bldg.,  Toronto,  Can. 
May  9-10,  1916. — North  Dakota  State  Dental  Association. — A.  Hallenberc,  Fargo,  No. 

Dak.,  Chairman  Exhibit  Committee. 
May  9-12, 1916. — ^Texas  State  Dental  Association,  Dallas,  Tex. — W!  O.  Talbot,  Fort  Worth, 

Tex.,  Secretary. 
May  9-12,  191 6. — Illinois  State  Dental  Society,  Springfield,  111. — Henry  L.  Whipple, 

Quincy,  111.,  Secretary. 
May  11-13,  1916. — Dental  Society  of  the  State  of  New  York,  Hotel  Ten  Eyck,  Albany,  N.  Y. 

— A.  P.  Burkhart,  52  Genesee  St.,  Albany,  N.  Y.,  Secretary. 
May,  16-18,  1916. — Susquehanna  Dental  Association,  Young  Men's  Hebrew  Association 

Bldg.,  Scranton,  Pa. — Geo.  C.  Knox,  30  Dime  Bank  Bldg.,  Scranton,  Pa.,  Recording 

Secretary. 
May  16-18,  1916. — Nebraska  State  Dental  Society,  Lincoln,  Neb. — H.  E.  King,  Omaha, 

Neb.,  Secretary. 
May  17-18,  1916. — Indiana  State  Dental  Association,  Claypool  Hotel,  Indianapolis. — A.  R. 

Ross,  Lafayette,  Secretary. 
May  i8r-20,  1916. — Lake  Erie  Dental  Association,  Hotel  Bartlett,  Cambridge  Springs,  Erie, 

Pa. — J.  F.  Smith,  Secretary. 
June  1916. — Utah  State  Dental  Society,  Salt  Lake  City. — E.  C.  Fairweather,  Salt  Lake 

City,  Utah,  Secretary. 
June  1-3,  1916, — Northern  Ohio  Dental  Association,  Cleveland,  O. — Clarence  D.  Peck, 

Sandusky,  O.,  Secretary. 
June  &-10,  1916. — Georgia  State  Dental  Society,  Macon,  Ga. — M.  M.  Forbes,  Candler 

Bldg.,  Atlanta,  Ga.,  Secretary. 


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274  THE  DENTAL  DIGEST 

June  13-15,  1916. — Connecticut  State  Dental  Association,  Hotel  Griswold,  New  London, 

Conn. — Elwyn  R.  Bryant,  New  Haven,  Conn.,  Secrdary, 
June  14,  1916. — South  Carolina  State  Board  of  Dental  Examiners  will  be  held  at  Jefferson 

Hotel,  Columbia,  S.  C. — R.  L.  Spencer,  Bennettsville,  S.  C,  Secretary. 
June  21,  1916. — Florida  State  Dental  Society,  Orlando,  Fla. — M.  C.  Izlar,  Corresponding 

Secretary, 
June  20-22,  1916. — New  Hampshire  Dental  Society,  Lake  Sunapee,  Zoo-Nipi  Park  Lodge, 

Lisbon,  N.  H. — J.  E.  Collins,  Chairman  Exhibit  Committee. 
Juj.e  26,  1916. — North  Carolina  State  Board  of  Dental  Examiners,  Battery  Park  Hotel, 

Asheville,  N.  C. — F.  L.  Hunt,  Asheville,  Secretary. 
June    27-29,    1916. — Pennsylvania    State   Dental    Society,  Pittsburgh,    Pa. — Luther  M. 

Weaver,  .103  Woodland  Ave.,  Philadelphia,  Pa.,  Secretary. 
June  28-30,  1916. — North  Carolina  State  Dental  Society,  Asheville,  N.  C. — R.  M.  Squires, 

Wake  Forest,  N.  C,  Secretary. 
June  29-July  30,  191 6. — Maine  Board  of  Dental  Examiners. — ^Harold  L.  Eicmons,  Masonic 

Bldg.,  Saco,  Me.,  Secretary. 
July  11-13,  1916. — South  Carolina  State  Dental  Association,  Chick*s  Springs,  S.  C. — ^Ernest 

C.  Dye,  Greenville,  S.  C,  Secretary. 
July  11-13,  1916. — ^Wisconsin  State  Dental  Society  Meeting,  Wausau. — ^Theodore  L.  Gil- 

berton.  Secretary. 
July  12-15, 19 1 6. — New  Jersey  State  Dental  Society,  Asbury  Park,  N.  J. — ^John  C.  Forsyth. 

Trenton,  N.  J.,  Secretary. 
July  20-22,  19 16. — American  Society  of  Orthodontists,  Pittsburgh,  Pa.  Address  communica- 
tions to  F.  M.  Casto,  520  Rose  Bldg.,  Cleveland,  O. 
July  24,  1916. — Kentucky  State  Dental  Society,  Louisville  Ky. — W.  T.  Farrar,  519  Starks 

Bldg.,  Louisville,  Secretary. 
July  25-28,  1916. — National  Dental  Association,  ist  Regiment  Armory,  Louisville,  Ky. — 

Otto  U.  King,  Huntington,  Ind.,  Secretary. 
October  9-15,  1916. — Arizona , Board  of  Dental  Examiners,  Phoenix,  Ariz. — Eugene  Mc- 

Guire,  302  Noll  Bldg.,  Phoenix,  Secretary. 
October  i8r-20,  19 16. — ^Virginia  State  Dental  Association,  Richmond,  Va. — C.  B.  Gotord, 

Norfolk,  Va.,  Corresponding  Secretary. 
January  23-25,  191 7. — American  Institute  of  Dental  Teachers,  Philadelphia,  Pa. — Abram 

TiorFMAN,  529  Franklin  St.,  Buffalo,  N.  Y.,  Secretary-Treasurer. 


FOLLYGRAPHS 

By  Oscar  Schleif 


Consultation,  operation. 
A  sweet  tooth  usually  needs  filling. 
Love  one  another,  but  not  another  one. 
It's  the  trying,  not  the  doing,  that  counts. 
There's  many  a  gossip  twixt  the  cup  and  the  lip. 
None  can  think  time,  but  who  has  lived  it. 
Laugh  if  the  world  will  borrow,  weep  if  you  get  a  loan. 
What  truth  is  stranger  than  that  facts  make  fiction,  and  fiction  cer- 
tainly is  a  fact? — Physical  Culture, 


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The  Dental  Digest 

GBORGB  WOOD  GLAPP,  D.D.S.,  Editor 

Published  monthly  by  The  Dentists'  Supply  Company,  Candler  Bldg., 
Times  Square,  220  West  42d  Street,  New  York,  U.  S.  A.,  to  whom  all  com- 
munications relative  to  subscriptions,  advertising,  etc.,  should  be  addressed. 

Subscription  price,  including  postage,  $1.00  per  year  to  all  parts  of  the 
United  States,  Philippines,  Guam,  Cuba,  Porto  Rico,  Mexico  and  Hawaiian 
Islands.    To  Canada,  $1.40.     To  all  other  countries,  $1.75. 

Articles  intended  for  publication  and  correspondence  regarding  the  same 
should  be  addressed  Editor  Dental  Digest,  Candler  Bldg.,  Times  Square, 
220  West  42d  Street,  New  York,  N.  Y. 

The  editor  and  publishers  are  not  responsible  for  the  views  of  authors  ex- 
pressed in  these  pages. 

Entered  as  Second  Class  Matter,  at  the  Post-OflSce  at  New  York  City. 
Under  the  Act  of  Congress,  March  3,  1879. 


Vol.  XXI 1 


MAY,  1916 


No.  5 


FOOD  FOR  DENTISTS* 

By  Watson  W.  Eldridge,  M.D.,  New  York 

IVe  recently  learned,  by  practical  experience,  that  wonderful  benefit 
results  from  a  course  of  diet  which  does  away  with  constipation.  So 
great  has  been  my  own  benefit,  that  I'd  like  to  have  all  understand  the 
relations  between  constipation  and  ill  health,  and  then  between  correc- 
tion of  the  trouble  and  joy  in  lixang,  so  I  got  Dr.  Eldridge  to  prepare 
these  articles.  Compare  the  story  told  in  this  one  with  some  of  your 
own  experiences. — Editor. 

EFFECT  OF  CONSTIPATION  ON  THE  NERVOUS  SYSTEM  AND  THE  MENTALITY 

SECOND  PAPER 

Of  all  the  abnormal  conditions  which  afflict  mankind  by  their  oc- 
currence in  the  himian  body,  probably  none  receives  as  little  thoughtful 
attention  by  the  individual,  as  chronic  constipation.  One  would  sup- 
pose, that,  in  view  of  the  many  lamentable  conditions  which  are  secondary 
to,  and  superimposed  on,  this  primary  condition,  the  subject  would  re- 
ceive more  interested  attention  from  the  public  in  general.  It  is  probably 
due  to  ignorance  of  the  consequences  that  leads  most  of  us  to  neglect 
the  primarily  simple  condition  of  constipation  until  after  the  almost 
disastrous  results  have  become  apparent. 
*  Continued  from  March  Digest 


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276  THE  DENTAL  DIGEST 

I  have  shown  in  a  previous  article  how  easily  the  vicious  cycle  of 
constipation  may  become  established  by  being  induced  through  sedentary 
habits  and  I  gave  the  prophylaxis  of  this  condition. 

SOME   RESULTS   OF   CONSTIPATION 

We  now  have  to  consider  some  of  the  results  of  a  well  established 
chronic  intestinal  stasis,  and  in  this  paper  only  those  relating  to  the 
nervous  system  will  be  discussed.  These  run  all  the  way  from  a  simple 
mental  stupidity,  to  epilepsy  and  include  loss  of  concentration,  loss  of 
intellectual  productive  ability,  various  manifestations  of  hysteria,  chorea 
(of  which  St.  Vitus'  dance  is  one  manifestation),  neuritis,  myalgia, 
(pain  in  the  muscles,  of  which  intercostal  neuralgia  is  a  specimen), 
sciatica,  lumbago,  and  mental  x)bsessions. 

PROCESS,   CONNECTING  CAUSE  AND  RESULT 

To  the  layman  it  is  a  far  cry  from  constipation  to  epUepsy  or  lumbago 
but  let  us  see  '^  the  wheels  go  round,"  and  observe  the  connection. 

Beside  the  digestion  produced  by  the  enzymes  of  the  stomach  and 
intestines  there  occurs  in  every  man  a  digestion  brought  about  by  the 
action  of  the  bacteria  which  normally  live  and  thrive  in  the  digestive 
tract.  These  bacteria  are  useful  and  necessary,  inasmuch  as  they  are 
the  only  means  the  human  organism  possesses  with  which  to  produce 
complete  digestion.  The  digestive  juices  and  enzymes  excreted  by  the 
various  glands  along  the  alimentary  tract  carry  the  digestive  process  to  a 
certain  point  only,  and  were  it  not  for  the  presence  of  the  bacteria  in  the 
lower  parts  of  the  canal  a  large  amount  of  nutritive  material  would  be 
wasted.  It  is  even  doubtful  if  life  could  be  long  sustained  on  the  amount 
of  nutritive  material  absorbed  from  the  products  of  the  enzyme,  diges- 
tion alone.  There  are  bacilli  which  convert  starches  into  sugar,  others 
which  emulsify  fats,  still  others  which  transform  albumin  into  peptones, 
etc.  The  action  of  the  microbes  is,  however,  not  limited  to  that;  in 
contradistinction  to  the  gastric  and  intestinal  enzymes,  it  goes  much 
farther  in  the  splitting  of  the  albuminous  molecule  and  finally  we  have, 
as  a  by-production,  such  toxic  substances  as  the  leucomaines,  neurin, 
and  muscarin,  and  the  ptomaines,  cadaverin  and  putrescin,  and  many 
others.  As  Combe  says  " — the  microbes  intervene  actively  in  all  the 
digestive  processes,  but  beside  their  undeniably  useful  role  it  is  also  un- 
deniable that  their  action  transforms  the  digestive  canal  even  in  the 
normal  state  into  a  receptacle  and  constant  laboratory  of  poisons." 
Under  normal  conditions  these  poisons  are  taken  care  of  by  the  body's 
defense  organization  which  consists  of  three  separate  systems,  i.  e.,  the 
intestinal  mucosa,  the  liver,  and  the  various  glands  of  internal  secretion. 


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FOOD  FOR  DENTISTS 


277 


These  are  all  conceded  to  have  an  antitoxic  function  and  the  exercise  of 
this  function  prevents  the  intestinal  toxins  from  producing  their  harmful 
influence  on  the  body  organism,  when  these  tvxins  are  produced  in  moderate 
and  normal  amount  only.  In  constipation,  these  toxic  bodies  are  present 
in  excessive  amounts.  Not  only  is  the  toxic  material  which  should  have 
been  evacuated,  retained,  but  this  very  retention  provides  a  splendid 
media  m  which  the  bacteria  are  stimulated  to  increased  activity  and 
greater  amounts  of  toxins  are  produced  to  be  added  to  these  already 
present.     When  this  process  has  developed  to  a  certain  point  the  anti- 


He  has  become  very  irritable,  is  easily  angered;  and  anything  but  a  pleasant  companion 
to  those  associated  with  him  in  his  work 

toxic  function  of  the  intestinal  lining,  or  mucosa,  is  overwhelmed  and 
the  poisons  are  absorbed  into  the  portal  circulation.  The  liver  then  soon 
becomes  surcharged  with  the  toxins  and,  after  a  certain  enlargement  due 
to  its  effort  to  stem  the  tide  of  toxic  material,  its  function  in  turn  be- 
comes weakened,  and  is  defeated  in  the  fight  to  prevent  the  passage 
of  these  bodies,  and  they  escape  into  the  general  circulation.  The 
antitoxic  bodies  in  the  bloodstream,  which  have  been  provided  by  the 
glands  of  internal  secretion  (thyroid,  suprarenals,  etc.),  now  take  up 
the  battle  and  for  awhile  the  onward  march  of  the  toxins  is  arrested, 
but  sooner  or  later  the  antibodies  are  in  their  turn  overwhelmed  and  the 
individual  then  develops  a  true  toxemia,  cither  acute  or  chronic,  but 


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278  THE  DENTAL  DIGEST 

usually  the  latter,  because  the  defensive  system  keeps  up  the  fight  and 
succeeds  in  nine  cases  out  of  ten  in  preventing  such  a  profound  toxemia 
that  the  patient  becomes  acutely  ill. 

Now  the  question  arises  as  to  what  effect  on  the  body  organism  is 
produced  by  the  presence  in  the  blood  stream  of  these  toxic  materials? 
It  has  been  shown  that  with  their  other  detrimental  activities  they  attack 
not  only  the  peripheral  nerves  but  the  nerve  centres  as  well.  The 
sequence,  severity,  and  character  of  the  nervous  symptomatology  pro- 
duced is  directly  dependent  respectively,  on  the  time  the  toxin  attacks  a 
particular  site,  the  virulence  of  the  toxin  itself,  and  the  part  of  the 
nervous  system  attacked.  Affections  of  the  peripheral  nerves  and  nerve 
terminations  produce  neuritis,  muscular  pains  and  perversions  of  the 
sensory  nerves,  lumbago,  and  may  induce  skin  lesion§  such  as  herjjes 
zoster  or  "shingles*'  (eruption  along  the  course  of  a  nerve).  If  the  nerve 
trunks  are  affected,  sciatica,  neuralgia,  headaches,  and  their  similitudes 
may  result;  while  more  deep  seated  attacks,  delivered  at  the  nerve 
centres,  may  produce  paralyses  of  various  sorts,  pseudo-epilepsy,  and 
last  but  by  no  means  least,  mental  disturbances  may  result  and  we  see 
apprehensions,  obsessions,  melancholia,  loss  of  concentration,  changes 
in  character  and  characteristics  and  psychic  disorders  too  niunerous  to 
mention. 


Let  me  quote  you  a  typical  case  history  of  one  of  the  so-called  nervous 
patients.  He  complains  of  not  having  felt  well  for  some  time,  but 
without  any  idea  as  to  the  cause  of  the  trouble.  He  has  grown  pale 
and  listless.  Appetite  is  poor  and  he  has  some  headache  and  vertigo. 
He  may  have  had  "sinking  spells''  in  which  he  actuaUy  lost  conscious- 
ness or  felt  that  he  was  going  to.  He  has  become  very  irritable  and 
sullen,  is  easily  angered  and  his  character  may  have  changed  from  that 
of  an  optimist  to  that  of  a  pessimist.  He  has  spells  of  melancholia,  and 
is  troubled  alternately  with  insomnia  and  lethargy.  He  may  have  had 
no  apparent  symptoms  of  indigestion  and  will  tell  the  physician  his 
stomach  is  all  right.  Close  questioning  may  elicit  the  information  that 
he  sometimes  has  spells  of  belching  after  meals  and  may  pass  quantities 
of  gas  by  rectum.  He  has  reached  the  point  where  he  can  no  longer  do 
a  full  day's  work  at  the  office,  due  to  mental  and  physical  exhaustion 
which  follows  a  comparatively  small  amount  of  work.  He  cannot  con- 
centrate his  mind  on  the  details  of  his  business  and  he  has  become  any- 
thing but  a  pleasant  companion  to  his  family  and  those  associated  with 
him  in  his  work.  He  has  probably  been  "constipated,  off  and  on"  for 
several  months  or  years  but  he  "always  takes  a  dose  of  salts"  or  some 


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FOOD  FOR  DENTISTS 


279 


patent  cathartic  pill  which  **fixes  it  up  all  right"  so  that  he  has  "no  trouble 
that  way." 


INCORRECT  DIAGNOSIS 


The  diversity  and  multitude  of  symptoms  enumerated  by  this  com- 
plaining and  grouchy  patient  will  give  the  physician  much  embarrassment 
in  forming  a  diagnosis.  All  the  organic  systems  seem  to  be  involved 
except  the  digestive  system,  but  it  is  this  very  multiplied  and  diversified 


^$»*^'^f»0S  Pf^^ 


The  patient  becomes  actually  ill 


quantity  of  symptoms  that  should  lead  to  an  investigation  of  the  digestive 
tract.  From  the  ignorant  or  too  busy  physician  the  patient  will  be  told 
that  it  is  because  he  has  a  nervous  constitution  and  will  be  advised  not 
to  worry  over  it.  It  is  just  this  sort  of  case  that  should  receive  the 
closest  attention.  The  stools,  urine  and  stomach  contents  should 
be  careftdly  examined.  The  physician  should  question  the  patient  in 
great  detail  so  as  to  bring  out  history  points  which  the  patient  may  have 
overlooked.  Careful  methods  of  examination  will  usually  reveal  con- 
stipation to  be  the  cause  of  these  numerous  and  diverse  symptoms  and 
the  patient  who  supposed  he  would  be  afflicted  the  rest  of  his  life,  owing 
to  a  "nervous  constitution,"  will  be  far  on  the  road  toward  relief. 

To  he  continued 


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280  THB  DSNTAL  DIGSST 


WHY  DISCARD  THE  TOOTH  BRUSH?    IT  CAN  BE  EASILY 

STERILIZED 

By  Ernest  C.  Dye,  A.B.,  D.D.S.,  Greenville,  S.  C. 

I  suppose  the  best  possible  comment  I  can  make  on  this  article  is  that 
after  reading  it  I  threw  away  all  the  tooth  brushes  in  my  family  and 
provided  each  member  with  a  glass  jar  containing  a  little  formalin. 
Now,  when  I  look  at  them,  I  feel  that  we  are  not  unnecessarily  and  care- 
lessly adding  to  the  collection  of  germs  already  in  our  mouths. — 
Editos. 

"More  than  a  million  organisms  have  been  found  by  bacteriologists 
on  the  bristles  of  eight  out  of  twelve  tooth  brushes,  after  they  had  been 
once  used.  A  number  comparable  with  that  found  in  sewage."  This 
statement  so  alarmed  Dr.  Bernard  Feldman  of  N.  J.  that  he  advocates 
discarding  the  tooth  brush  and  giving  us  as  its  substitute  **  The  clean  fore- 
finger" which  is  a  custom  of  semi-civilized  and  barbarous  nations. 

Is  it  not  strange  that  Dr.  Feldman  should  accept  the  statements 
and  experiments  of  these  bacteriologists  and  then  reject  their  remedy 
without  any  consideration?    Does  his  substitute  better  conditions? 

Here  follows  the  article  from  which  the  good  Doctor  quotes  in  his 
"Menance  of  the  Tooth  Brush":— 

"Recent  experiments  show  that  the  great  majority  of  tooth  brushes 
are  in  a  disgusting  stage  of  uncleanliness  and  so  ladened  with  germs  that 
they  are  capable  of  spreading  all  sorts  of  disease.  A  brief  ablution  under 
the  tap  or  in  a  tumbler  after  using  is  all  the  cleansing  the  average  tooth 
brush  ever  receives  and  this  is  totally  inadequate  to  render  it  reasonably 
clean.  In  these  experiments  each  of  twelve  sterile  brushes  was  once 
used,  rinsed  ten  times  in  a  tumbler  of  water  and  after  standing  twelve 
hours  all  the  bristles  were  removed  with  sterile  forceps  and  examined  for 
germs.  In  eight  out  of  twelve  cases,  more  than  a  million  organisms  were 
found,  a  number  comparable  with  that  found  in  sewage.  The  brushes 
examined  had  been  used  by  persons  suffering  from  diseases  of  the  teeth 
and  gimis.  But  four  brushes  used  by  persons  with  apparently  healthy 
mouths  revealed  almost  as  large  a  number  of  bacteria.  Antiseptic  pow- 
ders and  pastes  are  helpful  in  keeping  brushes  clean;  but  even  they  are 
not  sufficient. 

"  Experiments  with  seven  such  preparations  showed  that  there  ¥ras 
an  appreciable  reduction  in  the  number  of  organisms,  with  two  others 
there  was  practically  no  change,  while  with  three  others  there  was  no 
appreciable  improvement. 

"  What  makes  the  tooth  brush  particularly  dangerous  is  that  each 
bristle  point  acts  as  an  inoculating  needle  in  carrying  the  microbes 


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WHY  DISCARD  THS  TOOTH  BRUSH?  281 

into  the  delicate  membranes  of  the  gums.  As  the  brush  should  be  used 
at  least  twice  a  day,  the  gums  get  no  chance  to  throw  off  one  infection 
before  another  is  forced  upon  them.  Dr.  Ernest  C.  Dye  of  Greenville, 
S.  C,  has  invented  a  tooth  brush  with  a  hollow  handle  to  meet  these 
difficulties.  As  soon  as  the  brush  has  been  used  the  bristle  end  is  un- 
screwed and  stuck  into  the  hollow  handle.  In  the  inside  of  the  handle 
a  few  drops  of  formaldehyde  or  some  other  powerful  disinfectant  are 
kept.  The  fumes  of  the  disinfectant  sterilize  the  brush  before  the  next 
use.  The  same  results  may  be  obtained  by  keeping  the  ordinary  tooth 
brush  in  a  wide  necked  bottle  or  fruit  jar  or  any  receptacle  which  can 
hold  the  brush  and  a  few  drops  of  sterilizer.     It  must  be  air  tight." 

This  article  was  written  by  Drs.  Smale  and  Jones  of  London,  England. 
The  former  a  dentist,  the  latter  a  bacteriologist  in  the  employ  of  the 
British  Government.  It  first  appeared  in  the  Star  Co.  of  London,  copied 
in  this  country  by  the  New  York  Sunday  American,  Dec.  6,  1914,  and 
then  by  various  papers  throughout  the  United  States  and  Canada. 

Why  discard  the  tooth  brush?  Let  us  ask  the  following  questions. 
Which  would  be  the  easier  task,  to  teach  the  public  to  unlearn  something 
that  it  is  accustomed  to,  and  adopt  a  measure  which  is  novel,  or  to 
improve  that  which  it  now  has?  We  rather  think  the  latter  plan  more 
feasible;  therefore  let  us  sterilize  the  tooth  brush. 

The  medical  profession  has  taught  the  necessity  of  precaution  and 
sanitation,  and  as  the  result  of  this  we  are  "screening"  against  the  in- 
sidious mosquito  and  the  house-fly.  Civic  authorities  are  most  careful 
in  the  inspection  of  "backyards"  and  places  that  breed  germs  and 
disease.  The  "public  drinking  cup"  is  no  longer  tolerated,  thus  a 
"consciousness"  has  been  created  which  demands  sanitation  and 
sterilization. 

Drs.  Smale  and  Jones  have  shown  that  the  bristles  of  septic  tooth 
brushes  act  as  inoculating  needles,  and  that  the  germs  found  on  them 
will  produce  disease.    They  are  the  authors  of  the  following  article: 

"Bacteriology  of  Tooth  Brushes"  {British  Medical  Journal  1910J: 
"It  is  claimed  by  Smale  and  Jones  that  a  tooth  brush  becomes  septic 
after  one  using.  Each  hair  becomes  an  inoculating  needle  and  the 
person  using  it  may  be  vaccinated  with  such  germs  as  flourish  on  it.  The 
tooth  brush  therefore,  as  popularly  used  by  the  ignorant  for  many  months; 
may  be  the  origin  of  pyorrhoea  alveolaris,  gastritis,  and  arthritis.  The 
prevalent  tooth  powders  and  tooth  pastes  as  commonly  used  do  not 
render  the  tooth  brush  aseptic  and  even  a  solution  of  i  in  20  carbolic 
acid  is  not  effectual.  The  authorities  insist  that  all  tooth  brushes  should 
be  boiled  for  five  minutes  before  and  after  use.  A  new  tooth  brush  can 
be  used  each  day.    Those  wishing  for  a  more  prolonged  use  of  a  tooth 


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282  THE  DENTAL  DIGEST 

brush  can  rinse  the  brush  m  tricresol  (i  per  cent.)  or  allow  it  to  stand 
between  use  in  formalin  (lo  per  cent.). 

"A  tooth  brush  sterilizer  can  be  made  very  readily  with  practically  no 
expense,  even  by  the  uninitiated. 

**A11  that  is  needed  is  ^a  wide  necked  bottle  or  a  fruit  jar/  place  in 
it  a  few  drops  of  formaldehyde  on  cotton.  Now  the  tooth  brush,  and 
cork  up  air  tight.  In  less  than  an  hour's  time  all  organisms  will  have 
been  killed.    The  brush  is  put  into  the  sterilizer  while  it  is  damp. 

"  The  writer  has  used  such  a  sterilizer  for  three  years,  with  good  re- 
sults; there  is  no  injury  to  the  handle,  nor  the  bristles  of  the  brush  (as 
claimed  by  Dr.  Feldman,  bone  and  celluloid  handled  brushes  being 
used).  Neither  is  there  any  injury  to  the  teeth  nor  the  soft  tissues. 
The  brush  is  held  under  the  tap  or  rinsed  in  a  glass  of  water  before 
using." 

"An  Aseptic  Tooth  Brush"  (BriHsh  Medical  Journal  1913).  "In 
1910  Dr.  D.  W.  Carmalt  Jones  and  Mr.  Herbert  Smale  read  a  joint 
paper  before  the  British  Medical  Association  on  some  points  of  the 
'Bacteriology  of  Tooth  Brushes'  in  which  they  advocated  the  sterili- 
zation of  those  articles,  because  it  appeared  to  them  that  even  in  an  in- 
fected cavity  such  as  the  mouth,  it  was  preferable  that  an  instrument, 
which  is  so  used  that  it  may  scarify  the  gums,  should  not  convey  any 
additional  organisms  directly  into  the  wound.  This  appears  to  have 
attracted  some  attention  in  America,  and  Dr.  Carmalt  Jones  and  Mr. 
Smale  informs  us  that  an  American  dentist,  Dr.  Ernest  C.  Dye  of  Green- 
ville, S.  C,  has  devised  a  tooth  brush,  which  is  efficiently  sterilized  by 
formalin  vapor.  It  consists  of  a  cylinder  closed  at  one  end  by  a  hemi- 
spherical cap,  which  contains  wool  soaked  in  formalin  and  kept  in  place 
by  wire  gauze;  the  other  end  carries  the  brush  which  is  screwed  on  for 
use  and  after  use  is  reversed  and  screwed  inside  the  cylinder,  where  it  is 
exposed  to  the  formalin  vapor  and  rendered  sterile.  A  more  practical 
modification,  is  they  consider,  the  use  of  a  long  cylinder  in  which  an 
ordinary  tooth  brush  is  damp  when  put  into  the  cylinder  and  all  ordinary 
mouth  organisms  are  killed." 

Further  experiments  were  carried  on  by  Dr.  Wm.  Litterer,  A.  M., 
Ph.C.  M.D.,  Bacteriologist  of  Vanderbilt  University,  also  for  the  State 
of  Tennessee  (See  May  1913  and  May  1915  issues  of  Items  of  Interest). 
The  following  were  the  results  obtained: — 

"The  results  of  my  experiments  with  your  aseptic  tooth  brush  are  as 
follows: — 

"Experiments  were  made  with  full  strength  of  formalin  (formal- 
dehyde gas  40  per  cent,  in  water),  I  used  the  following  bacteria  to  test 
the  germicidal  power: 


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WHY  DISCARD  TKfi  TOOTH  BRUSH?  283 

"i.  Streptococcus  pyogenes. 

"2.  Staphylococcus  pyogenes  aureus. 

"3.  Bacillus  typhosus. 

"4.  Pneumococcus. 

"The  following  method  was  employed: — 

The  brush  was  rendered  sterile  by  superheated  steam  (Auto  Clave). 
The  brush  was  dipped  into  a  pure  culture  of  (i)  Streptococcus  pyogenes, 
and  was  then  returned  to  the  receptacle  to  be  acted  upon  by  the  formal- 
dehyde gas.  AJl  of  the  above  germs  were  treated  in  like  manner  and 
in  every  instance  double  controls  used.  Both  positive  and  negative 
controls.  The  result  was  that  complete  sterilization  was  effective  in 
less  than  an  hour's  time.  By  drying  the  brush  with  the  bacteria  adhering 
to  it  the  effectiveness  of  the  sterilization  was  greatly  impaired.  The 
above  results  were  obtained  by  using  only  the  full  strength  formalin. 
No  dilutions  were  used.  The  question  as  to  whether  it  would  be  too 
irritating  to  the  gums  can  be  answered  in  the  negative,  if  the  brush  was 
rinsed  in  water  before  using.  The  method  appears  to  be  a  very  effective 
and  unique  way  of  sterilizing  a  tooth  brush  and  in  my  opinion  should  be 
seriously  considered  by  the  dental  profession." 

It  is  to  be  hoped  that  this  discussion  of  the  unsanitary  condition  of 
the  tooth  brush  will  be  continued  until  the  dental  profession  takes  a 
stand  for  the  "sterilized  tooth  brush." 

The  immortal  Miller  a  generation  ago  proved  conclusively  that 
the  mouth  contains  hosts  of  germs  and  that  they  are  capable  of  pro- 
ducing decay  and  disease.  Will  not  this  generation  go  a  step  farther 
and  demand  that  the  instrument  with  which  we  brush  our  teeth  and 
gimis  "shall  be  clean?  " 

Can  the  dental  profession  take  the  **next  step"  that  Dr.  Mayo  speaks 
of  and  leave  the  tooth  brush  in  its  present  filthy  condition? 

REFERENCES 

Items  oflfUeresi,  May  1913,  May  1915. 

Pittsburg  Sunday  Post,  Dec.  6,  1914. 

Scientific  American,  Mar.  13,  1915. 

The  Dental  Cosmos,  191 1. 

British  Medical  Journal,  19 13. 

SotUh  Carolina  State  Journal,  1913. 

Oral  Hygiene,  Mar.  1915.     "Menace  of  the  Toothbrush." 

The  Literary  Digest,  191 5. 


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284  THE  DENTAL  DIGEST 


DENTAL  HYGIENISTS 

By  Edward  F.  Brown 

Secretary,  Dental  Group,  Advisory  Council  Committee  on  Child  Hygiene, 
New  York  City  Health  Department 

A  monograph  of  the  Department  of  Health  of  the  City  of  New  York 
states  that  it  is  safe  to  assume  tliat  not  less  than  ninety  per  centum 
(832,500)  of  school  children  of  the  city  are  in  need  ot  dental  treatment. 

It  may  be  said  that  this  situation  is  due  to  imperfect  tooth  structure, 
the  causes  of  which  lie  partly  at  least  in  prenatal  mal-hygiene,  improper 
feeding  of  children,  lack  of  cleansing  and  neglect  to  prevent  progressive 
decay  by  early  professional  treatment. 

The  insidious  character  of  tooth  decay  and  disease  is  becoming 
increasingly  apparent  from  the  scientific  relationships  being  drawn  be- 
tween mal-hygiene  and  disease. 

There  are  hardly  enough  licensed  dentists  to  repair  the  dental  ills 
of  the  school  population  alone. 

This  situation,  engaging  the  attention  of  school  hygienists,  has  di- 
rected attention  to  new  means  of  attacking  this  problem. 

It  was  apparent  that  little  was  to  be  expected  from  curative  channels 
in  any  effective  programme  of  action.  Prevention  is  the  keynote  of 
modem  health  work.  Inasmuch  as  the  prophylactic  principles  of  den- 
tistry are  defined,  it  was  patent  that  the  solution  lay  in  this  direction. 

For  some  time  Dr.  Alfred  C.  Fones  of  Bridgeport  had  been  success- 
fully experimenting  in  the  use  of  so-called  **  dental  hygienists"  or  speci- 
ally trained  women  who  give  surface  treatment  to  the  teeth  of  school 
children. 

Last  spring  Dr.  Philip  Van  Ingen,  chairman  of  the  Committee 
on  Child  Hygiene  of  the  Advisory  Council  of  the  Health  Department 
of  New  York,  in  conference  with  the  Health  Commissioner,  appointed 
the  following  members  of  the  Advisory  Council  of  the  Department  a 
committee  to  study,  report  and  recommend  as  to  the  desirability  of 
utilizing  dental  hygienists  in  New  York:  Dr.  Herbert  L.  Wheeler, 
Chairman,  Dr.  M.  L.  Rhein,  Dr.  Homer  C.  Croscup,  Dr.  Arthur  H. 
Merritt,  Dr.  Henry  C.  Ferris,  and  Edward  F.  Brown  of  the  Bureau  of 
Welfare  of  School  Children,  Association  for  Improving  the  Condition 
of  the  Poor,  as  Secretary. 

The  Committee  held  a  number  of  meetings,  and  on  February  8,  1916, 
submitted  the  following  unanimously: 

"The  sub-committee  on  dental  hygienists  held  three  meetings,  at 
which  time  the  question  of  dental  hygienists  was  thoroughly  discussed. 


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DENTAL  HYGIENISTS  285 

The  committee  now  begs  leave  respectfully  to  report  that  a  trial  of 
surface  cleansing  of  teeth  of  school  children  with  accompanying  instruc- 
tion in  oral  hygiene  be  commenced  at  the  earliest  possible  moment  in 
one  or  more  centres,  preferably  public  schools,  provided  that  the  work 
be  done  by  specially  and  adequately  trained  persons  and  under  the' 
supervision  of  competent  directors." 

On  February  17,  19 16,  the  whole  Committee  on  Child  Hygiene  of 
the  Advisory  Council  ratified  the  report  and  reconunendations  of  the 
sub-committee. 

Dr.  Haven  Emerson,  Commissioner  of  Health,  has  evidenced  the 
keenest  interest  in  this  work  and  it  appears  probable  that  at  an  early 
date  some  nurses  will  be  assigned  to  this  work. 

At  one  time  there  appeared  to  be  some  question  as  to  the  legality 
of  employing  dental  hygienists.  The  question  was  submitted  to  the 
Corporation  Counsel  by  the  Health  Commissioner  who  reported  that 
there  is  nothing  in  the  dental  law  to  prevent  the  use  of  dental  hygienists. 

In  order,  however,  to  avoid  any  possibility  of  untrained  persons  enter- 
ing upon  the  work  without  proper  safeguards  to  prevent  fraud,  ineffici- 
ency and  exploitation,  the  legislature  passed  a  bill  (Senate  Bill  No.  391) 
which  has  just  been  signed  by  Governor  Whitman,  the  provisions  of 
which  on  this  subject  are  as  follows: 

"Any  dental  dispensary  or  infirmary  legally  incorporated  and  reg- 
istered by  the  regents,  and  maintaining  a  proper  standard  and  equip- 
ment may  establish  for  women  students  a  course  of  study  in  oral  hygiene. 
All  such  students  upon  entrance  shall  present  evidence  of  attendance  of 
one  year  in  high  schools  and  may  be  graduated  in  one  year  as  dental 
hygienists,  upon  complying  with  the  preliminary  requirements  to  ex- 
amination by  the  board,  which  are: 

A.  A  fee  of  five  dollars. 

B.  Evidence  that  they  are  at  least  twenty  years  of  age  and  of  good 
moral  character. 

C.  That  they  have  complied  with  and  fulfilled  the  preliminary  and 
professional  requirements  and  the  requirements  of  the  statute. 

After  having  satisfactorily  passed  such  examination  they  shall  be 
registered  and  licensed  as  dental  hygienists  by  the  regents  under  such 
rules  as  the  regents  shall  prescribe. 

Any  licensed  dentist,  public  institution  or  school  authorities  may 
employ  such  licensed  and  registered  dental  hygienists.  Such  dental 
hygienists  may  remove  lime  deposits,  accretions  and  stains  from  the 
exposed  surfaces  of  the  teeth,  but  shall  not  perform  any  other  operation 
on  the  teeth  or  tissues  of  the  mouth.  They  may  operate  in  the  office  of 
any  licensed  dentist,  or  in  any  public  institution  or  in  the  schools,  under 


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286 


TH£  DENTAL  DIGEST 


the  general  direction  or  supervision  of  a  licensed  dentist,  but  nothing 
herein  shall  be  construed  as  authorizing  any  dental  hygienist  perform- 
ing any  operation  in  the  mouth  without  supervision.  The  regents  may 
revoke  the  license  of  any  licensed  dentist  who  shall  permit  any  dental 
hygienist  operating  under  his  supervision  to  perform  any  operation  other 
than  that  permitted  under  the  provisions  of  this  section." 

This  law  follows  the  enactment  of  similar  ones  in  Massachusetts 
and  Connecticut.  With  these  progressive  steps  taken,  it  is  to  be  hoped 
that  through  prevention  we  will  preclude  the  possibility  of  another 
generation  of  children  growing  up,  90  per  cent,  of  whom  will  be  exposed 
to  the  havoc  wrought  by  diseased  and  rotting  teeth. 


OUR  ANNUAL  GOOD  FELLOWSHIP  DINNER,  1916 


This  is  the  picture  of  the  Annual  Good  Fellowship  Dinner  given  at 
the  end  of  the  Clinic  and  Exhibit  of  the  Marquette  Alumni  meeting 
each  year.  We  had  some  stunts  on  the  stage  and  as  we  drank  our 
famous  beer  we  sang  our  college  songs  and  then  flew  away  like  the 
swallows  to  meet  again  next  year.  Dr.  Albert  Frackelton. 


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THE  CLINICS  AT  THB  NATIONAL  MEETING  287 


THE  CLINICS  AT  THE  NATIONAL  MEETING 

For  many  years  the  meetings  of  the  National  Dental  Association  were 
conducted  without  clinics.  It  was  deemed  that  the  dignity  of  that  body 
would  be  lowered  by  demonstrations  by  mechanics  to  show  how  to  do 
things.  The  entire  time  of  the  sessions  was  given  over  to  scientific  and 
near-scientific  papers  and  their  discussion. 

Now  the  success  of  all  dental  meetings,  including  the  National,  is 
measured  by  the  number  and  character  of  its  clinics  as  much  as,  or  even 
more  than  by  the  papers  that  are  read. 

Hence  a  foreword  anent  the  clinical  programme  for  the  meeting  of  the 
National  at  Louisville  in  July,  will  not  be  without  interest. 

In  the  first  place,  the  fact  that  Dr.  Wm.  H.  G.  Logan  of  Chicago  is 
National  Chairman  of  Clinics  gives  assurance  that  this  feature  will  be  of 
the  highest  order  of  excellence  and  that  the  plan  of  its  conduct  will  be  an 
example  of  organization  such  as  he  alone  is  master  of. 

Though  the  details  are  not  yet  complete,  the  following  may  be  given 
out  as  the  frame  work  of  the  plan  which  has  practically  been  decided 
upon. 

On  Wednesday  afternoon  from  1 130  to  5,  at  Keith's  Theater  (seating 
capacity  3,000,  ventilated  with  washed  and  refrigerated  air — ^important 
items  in  July)  there  will  be  given  fifteen-minute  lectures  illustrated  with 
stereopticon  and  moving  pictures,  on  subjects  of  the  most  vital  interest 
to  dental  practitioners  of  to-day,  and  by  men  specially  selected  for  their 
knowledge  and  their  ability  to  impart  it  in  effective  concentrated  fifteen- 
minute  doses. 

Ftiday  morning  at  9:30,  and  until  12:30,  a  sectional  Progressive 
Clinic  will  be  conducted  in  the  balcony  of  the  Armory  which  will  present 
some  new  and  novel  features  in  the  way  of  a  progressive  clinic.  The 
arrangements  will  be  such  that  everybody  will  see  every  clinic  without 
discomfort  or  inconvenience. 

These  clinics  are  to  be  given  by  dentists  residing  in  the  district  of  the 
National  in  which  Louisville  is  located  and  comprises  the  States  of  Michi- 
gan, Indiana,  Kentucky  and  Tennessee. 

There  will  also  be  surgical  clinics  by  men  of  national  reputation,  at 
the  City  Hospital. 

Altogether  the  clinical  programme  offered  at  the  1916  meeting  of  the 
National  Dental  Association  will  be  worth  a  Sabbath  day's  journey  with 
part  of  Saturday  and  Monday  if  necessary,  to  come  to  Louisville  in  July 
to  see,  even  if  you  saw  or  heard  nothing  else. 


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288  THB  DBNTAL  DIGEST 


WHY  ARE  THERE  TWO  DENTAL  PROTECTIVE  ASSOCIATIONS? 

Since  the  recent  publication  of  the  report  of  the  Dental  Protective 
Association  of  the  United  States,  the  question  has  been  asked  many 
times:  "Why  are  there  two  dental  protective  organizations? " 

When  the  Dental  Protective  Association  entered  into  its  agreement 
with  Dr.  Taggart,  by  the  terms  of  which  Dr.  Taggart  agreed  to  license 
its  members  to  use  the  process  disclosed  in  his  patents,  for  the  sum  of 
$15,  and  by  which  it  agreed  not  to  participate  in,  or  contribute  to,  the 
defense  of  any  dentist  against  whom  Dr.  Taggart  might  bring  suit  for 
infringement  of  his  patents,  there  was  brought  about  in  the  dental  world 
a  condition  which  is,  in  itself,  an  answer  to  the  above  question. 

We  quote  from  the  article  published  in  various  dental  journals, 
which  is  dated  January  3,  191 6,  which,  among  other  things,  sets  forth 
the  status  of  the  members  of  the  Dentral  Protective  Association  with 
reference  to  the  pending  Taggart  litigation: 

"The  question  is  frequently  asked:  Where  does  the  individual 
stand,  with  reference  to  the  pending  Taggart  litigation,  who  is  a  member 
of  this  Association  in  good  standing  and  who  did  not  accept  the  terms  of 
the  agreement  with  Dr.  Taggart  before  the  time  limit  expired?  In  reply 
to  this  important  question  we  will  say  that  every  member  was  notified 
individually  and  through  the  dental  journals,  not  once  but  several 
times,  of  the  opportunity  afforded  by  the  terms  of  the  agreement;  and 
those  who  did  not  accept  forfeited  their  rights  to  protection  from  this 
source,  by  this  association.  They  are  hereby  notified  that  they  may  either 
settle  direct  with  Dr.  Taggart  or  MAKE  WHATEVER  OTHER  AR- 
RANGEMENTS THEY  SEE  FIT  TO  PROTECT  THEMSELVES 
FROM  THE  TAGGART  PATENTS." 

The  last  sentence  in  the  above  quoted  paragraph  is  the  main  reason 
and  answer  for  the  second  dental  protective  organization. 

After  the  agreement  with  Dr.  Taggart  was  effected  by  the  Dental 
Protective  Association,  and  after  the  dentists  of  the  country  had  been 
given  a  suitable  opportunity  to  avail  themselves  of  its  privileges,  if  they 
so  desired,  and  the  time  in  which  they  might  do  so  had  elapsed.  Dr. 
Taggart  commenced  a  campaign  to  coUect  money. 

Using  roimd  figures,  about  10  per  cent,  of  the  dentists  of  the  country 
availed  themselves  of  the  opportunity  afforded  by  the  Dental  Protective 
Association,  and  the  other  90  per  cent,  did  not.  There  were  just  two 
things  which  this  90  per  cent,  might  do:  the  one,  to  submit  and  pay; 
the  other,  to  organize  and  test  out  the  validity  of  the  Taggart  patents. 

A  group  of  Chicago  Dentists  decided  to  adopt  the  latter  course,  and 


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WHY  ARE  TH£R£  TWO  DBNTAL  PROTECTIVE  ASSOCIATIONS?      289 

at  a  meeting  held  at  the  Grand  Pacific  Hotel  in  June,  of  1914,  The 
Dentists'  Mutual  Protective  Alliance  came  into  being. 

The  purpose  of  the  Dentists'  Mutual  Protective  Alliance  is  the  pro- 
tection of  its  members  against  process  patent  exploitation.  While  the 
immediate  work  in  hand  is  the  Taggart  litigation,  yet  its  real  purpose 
is  to  be  in  the  field,  big  and  strong  and  ready  to  defend  the  dental  pro- 
fession against  all  those  who  have  unadjudicated  process  patents  to 
exploit.  This  position  is  assured  by  the  provisions  of  its  By-laws,  which 
reads  as  follows:  "No  process  patent  shall  be  compromised." 

Immediately  after  organization,,  the  management  of  the  Dentists' 
Mutual  Protective  Alliance  took  up  the  work  of  testing  the  validity  of 
the  Taggart  patents.  In  this  connection  it  may  not  be  understood  by 
all  dentists  just  how  or  just  what  must  be  proven  to  invalidate  a  patent. 
When  a  patent  is  granted  by  the  United  States  Patent  Office,  it  is  as- 
sumed that  whatever  is  claimed  therein,  is  new  or  novel.  If  it  can  be 
proven  beyond  a  reasonable  doubt  that  whatever  is  claimed  therein  as 
new  or  novel  was  in  use  more  than  two  years  prior  to  the  date  of  the 
patent,  the  patent  falls. 

The  work  of  the  Alliance  has  been  to  show  that  the  processes  dis- 
closed in  Dr.  Taggart's  patents,  were  in  use  more  than  two  years  prior  to 
the  date  of  his  patents,  or  prior  to  1905.  To  this  end  the  case  has  been* 
twenty  days  in  Court;  the  attorneys  of  the  Alliance  have  visited  most 
of  the  states  of  the  Union  from  Pennsylvania  to  Arizona,  getting  together 
evidence;  while  the  trial  was  in  progress  last  June,  they  had  more  than 
120  people  in  attendance,  either  directly  or  indirectly,  as  witnesses. 

The  triaJ  lasted  weU  into  July,  when  it  became  apparent  to  the 
Court  that  the  end  was  a  long  way  off,  and  he,  therefore,  adjourned  the 
case  until  the  Fall  Term,  subject  to  call.  During  the  winter  there 
have  been  several  days  of  argument  on  motions,  and  the  like,  and  it  is 
probable  that  the  main  case  will  be  caJled  at  an  early  date. 

The  present  case  is  what  is  known  as  a  test  case,  and  an  Appellate 
Court  decision  in  the  pending  litigation  will  be,  in  effect,  binding  through- 
out the^United  States.  Should  Dr.  Taggart  be  successful  in  this  litigation, 
the  question  to  those  who  do  not  have  Taggart  licenses,  will  be:  "How 
much  do  you  owe  Dr.  Taggart?"  On  the  other  hand,  if  the  Alliance  is 
successful,  the  Taggart  patents  fall. 

This  is  said  to  be  the  largest  and  most  important  piece  of  dental  patent 
litigation  that  was  ever  before  a  Federal  Court  for  adjudication.  The 
Dentists'  Mutual  Protective  Alliance  is  the  only  organization  in  the 
field  in  a  position  to  take  the  part  of  90  per  cent,  of  the  dentists  of  the 
country  in  that  litigation.  This  would  seem  to  be  a  sufficient  reason 
for  the  second  dental  organization. 


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290  TH£  DENTAL  DIGEST 

CLOSED  MOUTH  IMPRESSIONS* 

By  Samuel  G.  Supplee,  New  York,  N.  Y. 

FOURTH  paper 

proper  use  of  the  bunsen  burner 

A  Bunsen  flame  presents  three  distinct  temperatures. 

The  tip  of  the  flame  is  the  hottest  part;  and  if  it  is  brought  directly 
into  contact  with  the  modelling  compound,  it  will  cause  the  surface  to 
sizzle  or  bubble. 

The  middle  of  the  flame  is  what  might  be  termed  medium  warm; 
compound  passed  a  little  way  into  the  side  of  the  flame  will  be  heated 
slowly,  and  to  a  uniform  consistency  by  moving  it  back  and  forth. 

The  base  of  the  flame  is  the  coolest  part.  The  material  can  be  passed 
into  this  part  of  the  flame  more  slowly  without  danger  of  bubbles  and 
blisters,  and  the  heat  will  be  transmitted  to  a  greater  depth  without 
causing  the  surface  to  flow. 

Each  one  of  these  three  distinct  temperatures,  properly  applied,  is 
of  great  value  to  the  operator. 

THE  proper  size   OF  FLAME 

A  small  Bunsen  like  the  one  attached  to  the  Supplee  outfit  illustrated 
in  the  March  issue  should  be  used. 

The  Supplee  Bimsen  has  a  little  cock  attached  to  the  frame  to  regulate 
the  exact  height  of  the  flame. 

The  flame  should  be  a  clear  blue,  and  should  not  be  over  one  inch 
from  the  mouth  of  the  burner  to  the  tip  of  the  flame. 

A  flame  of  greater  volume  will  not  be  so  easily  controlled.  Many 
impressions  are  spoiled  when  the  attempt  is  made  to  transform  them 
from  an  impression  with  the  mouth  open  to  one  with  the  mouth  closed, 
by  using  too  large  a  flame  and  by  permitting  the  flame  to  glance  so  that 
it  will  heat  a  portion  of  the  impression  that  it  is  desirable  not  to  change. 

PREVENTING   THE   COMPOUND  ADHERING   TO   THE   FINGERS 

As  compound  cools  from  the  surface  and  is  exceedingly  sticky  when 
in  a  flowing  state,  the  Supplee  heating  apparatus  is  so  designed  that  the 
hot  and  cold  water  pans  are  close  together,  and  a  glass  spatula  is  furnished 
for  raising  the  compound  from  the  bottom  of  the  heater  pan  when  in  a 
semi-flowing  state. 

It  is  vital  that  the  spatula  with  the  compound  be  quickly  immersed 

•This  article  began  in  the  January,  191 6,  number 


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CLOSED  MOUTH  IMPRESSIONS  291 

in  cold  water  and  the  fingers  must  be  wet  before  an  attempt  is  made 
to  remove  the  compound  from  the  spatula.  Otherwise,  one  will  have 
considerable  trouble  with  the  material  sticking  to  the  fingers. 

If  the  water  in  which  the  compound  is  heated  is  hotter  than  170  de- 
grees, the  compound  will  become  very  sticky  and  will  adhere  to  fingers 
even  if  they  are  wet.  It  is  well  to  cool  it  before  proceeding,  as  this  will 
save  time. 

This  stickiness  can  be  avoided  by  letting  the  compound  lie  in  water 
at  160**  for  five  or  ten  minutes. 

In  taking  compound  from  hot  water  always  reach  to  the  bottom  of 
the  pan  and  scoop  up  the  compound  on  the  end  of  the  glass  spatula. 
Then  with  two  or  three  deft  turns  of  the  spatula,  lift  out  enough  com- 
pound for  an  impression  and  give  it  a  quick  dip  into  the  cold  water  pan 
before  attempting  to  remove  the  compound  from  the  spatula  with  wet 
fingers. 

The  thin  film  of  hardened  surface  compound  will  not  be  sticky.  By 
slightly  kneading  the  material,  this  film  is  dissolved  and  will  become  of 
the  same  consistency  as  the  rest  of  the  mass. 

Avoid  touching  compound  that  has  been  heated  over  the  flame  with 
either  dry  or  wet  fingers.  Dip  it  in  water  first,  but  avoid  permitting  the 
impression  tray  to  come  in  contact  with  the  hot  water,  as  aluminum 
absorbs  the  heat  rapidly. 

An  impression  tray  that  has  lain  in  water  of  165  degrees  cannot  be 
inserted  in  the  average  mouth  without  burning  the  patient  or  causing 
discomfort.    It  will  also  retard  the  setting  of  the  compound. 

EUMINATING  THE  ROCKING  OF  AN  UPPER  IMPRESSION 

During  the  manipulation  of  compound,  one  may  cause  an  impression 
to  rock. 

There  are  a  number  of  ways  to  eliminate  this  condition.  The  method 
to  be  employed  must  be  determined  by  the  case  in  hand. 

Where  the  ridge  is  hard  and  the  muscular  attachments  are  definite 
in  their  action,  heat  the  surface  of  the  water  to  about  170  or  175  degrees. 
Fill  a  Spooner  self-fillicfg  syringe  with  hot  water  two  or  three  times  and 
empty  it  so  as  to  thoroughly  heat  the  bulb  and  metal  part.  Then  fill 
it  with  hot  water  and  suspend  the  impression  over  the  pan  heels  down 
and  force  the  water  to  strike  over  the  centre  of  the  palatal  portion  and 
flow  to  the  bottom  of  the  ridge  in  front  and  off  at  both  sides  for  half  a 
minute.  Quickly  pass  into  the  mouth  and  gently  but  firmly  place  up  to 
position  by  bringing  pressure  with  the  index  finger  under  the  centre  of  the 
tray  and  have  the  patient  make  the  face  movements.  Hold  firm  until 
thoroughly  set. 


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292  THS  DENTAL  DIGEST 

If  the  rock  should  develop  after  you  have  established  the  biting 
block,  or  the  plane  of  occlusion,  follow  the  same  technique  as  already 
described  and  place  the  tray  in  the  mouth  and  have  the  patient  bite  it 
up  to  place  with  a  gentle  but  firm  pressure,  and  make  face  movements. 

Before  doing  this  adjusting,  one  must  be  sure  that  the  occlusal  sur- 
face of  the  compound  biting  block  is  flat  and  smooth  in  the  molar  and 
bicuspid  region.  If  the  opposing  cusps  are  embedded  in  it  to  a  depth  of 
even  half  the  thickness  of  a  cardboard,  it  will  interfere  with  the  proper 
correction  of  the  impression. 

HOW   COMPOUND   CAN   BE   SPOILED 

There  are  many  ways  in  which  compound  can  be  six)iled,  a  few  of 
which  are  as  follows: 

First,  by  over-heating.  As  soon  as  compound  has  lain  in  boiling 
water  for  a  few  minutes,  it  will  not  only  lose  its  quick  setting  qualities, 
but  when  it  does  set,  it  will  not  be  hard. 

If  left  lying  in  water  of  over  i8o  degrees  for  half  an  hour  or  more,  it 
will  not  set  quickly  or  nearly  so  hard. 

Compound  should  never  be  used  a  second  time. 

When  a  cast  has  been  poured  into  a  compound  impression,  the  plaster 
seems  to  extract  or  neutralize  some  of  its  qualities  so  that  it  not  only  sets 
slower,  but  is  more  difficult  to  work  and  will  not  secure  the  best  results. 

Many  impressions  are  failures  for  this  reason  alone.  They  are  easily 
bent  and  will  be  changed  materially  by  the  lips  when  taking  them  out 
of  the  mouth. 

After  compound  has  lain  in  water  of  120  degrees  or  more  for  over  five 
hours,  it  will  lose  many  of  its  qualities  for  quick  accurate  work. 

GLOSSING  CASTS 

By  using  a  ver\^  thin  solution  of  model  separating  varnish  or  water- 
glass  and  applying  it  over  the  surface  quickly  with  a  brush,  you  will 
give  to  the  cast  a  smooth  surface  which  is  conducive  to  a  better  finish 
on  the  completed  denture. 

Last,  but  not  least,  ice-water  or  cold  air  should  always  be  used  in 
cooling  compound  before  taking  it  out  of  the  mouth,  in  order  that  there 
may  be  no  changes  where  the  margins  are  thin. 


Aid  in  Soldering. — Use  the  base  of  an  inverted  gas  mantel  as  a 
soldering  base.  Place  it  on  your  asbestos  soldering  block.  The  flame 
will  have  easy  access  to  all  parts  of  investment,  and  you  will  lessen  your 
troubles  to  nil. — Nils  Juell,  D.D.S.,  Minneapolis,  Minn. 


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CAST-CUSP  GOLD  CROWN 


295 


CAST-CUSP  GOLD  CROWN 

By  a.  Bruce  Coffin,  D.D.S.,  Apache,  Okla. 

Prepare  root  in  the  usual  manner,  leaving  the  stump  in  the  shape  of 
a  cone  or  at  least  with  parallel  sides;  grind  off  occlusal  surface  so  that 
there  will  be  a  space  of  at  least  i§  mm.  between  it  and  the  occluding 
teeth  at  all  positions  of  the  mandible.  Make  band  in  the  form  of  a  cone 
after  the  method  of  Dr,  Prothero  which,  briefly,  is  as  follows: 


Take  card-board  5  inches  by  2^  inches  and  near  the  bottom  of  the 
left  margin,  make  another  mark  (b).  Using  the  lower  mark  (a)  as  a 
centre  make  the  arc  of  a  circle  starting  from  the  upper  mark  (b).  To 
mark  gold  plate  for  cutting  band,  take  wire  root  measurement,  cut  and 
bend  to  conform  to  the  curve  of  the  arc  on  card  and  mark  the  length 
from  (b)  on  the  arc.  Place  gold  plate  on  the  card  with  the  left  margin 
of  the  gold  on  the  left  margin  of  the  card  and  the  lower  edge  of  the  plate 
(if  it  be  a  rectangular  piece),  bisecting  the  arc  at  the  mark  indicating  the 
length  of  the  wire  measurement  (c).  Now  with  the  gold  plate  held  firmly 
in  place  mark  the  arc  (c)  on  the  plate;  with  a  straight  edge  bisecting  the 
(a)  and  (c)  mark  end  of  band;  with  radius  extended  the  width  you  wish 
the  band  mark  second  arc  on  plate  (d  e). 

Fit  band  to  root,  contour  and  set  band  in  place  on  stump.  See  that 
the  end  of  band  does  not  interfere  with  occlusion.  Warm  inlay  wax 
and  place  in  occlusal  portion  of  band  and  have  patient  bite  firmly  to- 
gether. Have  patient  bite  in  lateral  occlusion  and  by  any  possible 
movement  of  the  mandible  bite  down  wax.    Tack  wax  to  band  with 


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294  THB  DENTAL  DIGEST 

hot  instrument  at  several  places  on  the  periphery  of  band  but  do  not 
touch  occlusal  portion  of  wax.  Cool  wax,  remove  band  with  wax  in 
place  and  pour  band  full  of  investment  compound.  You  may  now 
dismiss  patient. 

When  investment  is  hard,  carve  occlusal  portion  of  crown  in  the  wax. 
Do  not  add  wax  to  the  occlusal  portion  but,  of  course,  wax  may  be  cut 
away  wherever  necessary,  leaving  the  original  occlusal  wax  where  you 
wish  the  crown  to  come  in  contact  with  the  occluding  tooth.  In  adding 
wax,  if  it  becomes  necessary,  use  a  color  contrasting  with  the  original  so 
that  if  the  occlusion  has  been  interfered  with  it  may  be  detected.  Cast 
by  usual  method. 

By  this  method  no  articulator  is  needed.  It  is  not  necessary  to 
refit  the  carved  wax  crown  on  the  tooth — ^if  indeed  it  were  possible  to 
do  so  without  distorting  the  wax,  provided  the  band  was  properly  fitted. 
By  filling  the  band  with  investment  compound  the  wax  is  prevented  from 
being  pushed  farther  into  the  band  thus  interfering  with  the  occlusion 
and  also  preventing  the  cast  crown  from  going  to  place. 

By  this  method,  with  acquired  skill,  a  perfect  anatomical  crown 
may  be  made  quickly  and  easily. 


PERFECT  ARTICULATION  IN  POSTERIOR  BRID6EW0RK  BT 
THE  USE  OF  TRUBYTE  MOLAR  BLOCKS 

R.  D.  Pray,  D.D.S.,  Sheridan,  Oregon 

The  ideal  place  for  restorations  of  this  character  are  where  the 
teeth  on  the  same  side,  both  upper  and  lower,  are  to  be  replaced.  Any 
restoration  back  of  the  cuspids  can  be  made  with  the  molar  blocks. 
If  one  or  more  teeth  are  to  be  used,  simply  cut  off  the  teeth  with  a  sep- 
arating disk,  saving  the  remaining  teeth  for  some  future  case.  In 
using  the  blocks,  for  work  of  this  character,  you  will  turn  out  bridge- 
work  that  is  pleasing  to  the  eye  and  anatomically  correct  in  principle. 
The  time  used  and  the  expense  will  be  less  than  if  you  had  used  all 
gold,  and  the  final  result  will  astonish  you.  For  illustration  take  two 
molar  blocks,  articulate  them  between  the  fingers,  then  look  ahead.and 
figure  how  you  can  obtain  that  result  on  your  next  case. 

There  is  nothing  difficult  about  using  the  molar  blocks  and  I  believe 
that  the  idea  has  great  possibilities  for  originality  in  the  operator's 
technique,  and  the  range  of  use  will  depend  entirely  upon  the  individual's 
mechanical  ability. 


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PERFECT  ARTICULATION  IN  POSTERIOR  BRIDGEWORK  295 

METHOD  OF  PROCEDURE 

Make  your  abutments  in  the  regular  manner,  take  your  bite  and  im- 
pression and  mount  on  an  anatomical  articulator.  Determine  size  and 
shade  of  blocks  to  be  used.  Then  grind  the  ends  of  block  imtil  they  fit 
snugly  between  abutments,  taking  care  that  the  articulation  is  perfect. 
Now  remove  blocks  and  with  a  small  stone  cut  out  the  undercuts  in  the 
diatoric  blocks,  then  grind  the  ends  that  lie  next  to  each  abutment  at 
about  a  45  degree  bevel — which  will  allow  for  the  strength  of  backing 
attachment  to  crowns.  Now  soften  your  inlay  wax  and  press  into  the 
back  of  block,  taking  care  that  the  wax  goes  well  up  into  the  holes,  shape 
up  wax  flush  with  edge  of  block,  or  for  added  strength  let  wax  extend  a 
trifle  below  edge.  Invest  wax  impression  and  cast  with  your  scrap  gold. 
This  backing  can  be  cast  in  one  piece  or  in  sections-as  you  like — ^possibly 
the  casting  in  sections  would  be  easier  and  more  accurate.  At  the 
final  soldering  they  will  be  all  joined  in  one  piece. 

After  the  casting  operation,  smooth  the  backing  until  it  will  go  into 
place  easily,  then  wax  all  parts  into  their  correct  positions  on  the  arti- 
culator, remove  blocks,  invest  the  case  and  solder.  Polish  the  work, 
cement  on  backings  and  you  have  a  beautifully  finished  piece  of  bridge- 
work  with  perfect  articulation. 

When  you  cut  a  tooth  off  the  blocks,  before  laying  it  aside  for  future 
use,  make  a  die  and  counter  die  of  it  so  that  you  can  carry  out  the  ana- 
tomical feature  on  the  crown  abutment  that  is  to  take  its  place. 

In  using  the  upper  and  lower  blocks,  it  will  not  be  necessary  to  do 
much  grinding  as  the  teeth  will  be  found  to  articulate  perfectly.  And 
in  cases  where  the  blocks  are  to  articulate  with  the  natural  teeth,  you 
will  find  that  they  will  articulate  easier  than  any  tooth  that  can  be 
used,  and  the  natural  appearance  of  the  case,  when  finished,  will  more 
than  compensate  you  for  the  care  taken. 


Dissolvable  Impression  Plaster. — F.  Duijvensz  recommends  a 
mixture  of  two  parts  of  potato  flour  and  ten  parts  of  plaster  of  Paris  to 
make  a  dissolvable  impression  plaster.  The  potato  flour  must  be  very 
dry.  The  mix  is  made  with  cold  water  to  which  a  pinch  of  table  salt  is 
added.  After  having  been  assembled,  the  impression  is  coated  with  a 
solution  of  one  part  of  potassium  or  sodium  silicate  (waterglass)  in  three 
parts  of  water,  and  the  cast  is  poured.  After  the  cast  has  set,  the  im- 
pression is  dissolved  away  in  boiling  water. — British  Journal  of  Dental 
Science. 


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{nNE/(/5viLDING 


The  only  business  which  is  good  busi- 
ness is  that  business  which  tends  to  build 
the  man  while  the  man  is  building  the 
business.— **A^ep/i//ie"—Ne*r.  Dent.  Jour, 


FIFTY-FIFTY 

W.  F.  Davis,  D.M.D.,  New  York  City 

Two  or  three  weeks  ago  I  felt  that  I  needed  a  little  rest  from  business, 
and  decided  that  I  would  visit  one  of  my  old  classmates,  who  soon  after 
his  graduation  had  located  in  a  town  a  couple  of  hundred  miles  north 
of  me.  I  had  never  heard  of  his  death  or  removal  from  the  original 
location  and  therefore  decided  that  he  must  have  remained  there.  I 
thought  I  would  take  a  chance  anyhow,  as  it  was  a  pleasant  section  of 
country  and  I  had  never  visited  it. 

Dave  Brown  was  one  of  the  brightest,  most  capable  and  most  popular 
members  of  the  class.  He  was  ambitious,  full  of  energy  and  everybody 
prophesied  a  briUiant  future  for  him. 

On  reaching  my  destination  I  readily  found  Dave's  office.  It  was 
centrally  located,  over  the  post-office.  As  I  entered  the  office  Dave 
came  out  from  his  little  laboratory  and  met  me  with  a  questioning  "what 
can-I-do-for-you"  look  that  changed  almost  instantly  to  recogm'tion. 

"Great  Heavens,  Tom!  You  dear  old  fellow!  I  can't  tell  you  how 
glad  I  am  to  see  you.  Sit  right  down  and  tell  me  all  about  yourself, 
and  the  rest  of  the  boys.  IVe  been  sort  of  side-tracked  up  here  and 
haven't  kept  in  touch  with  the  rest  of  the  class.  My,  but  I'm  glad  to 
see  you." 

We  gossiped  for  an  hour  or  so  about  old  times.  I  told  Dave  about 
myself,  where  I  was  located,  my  business,  my  family,  and  my  plans  for 
the  future.  Then  I  said:  "Tell  me  all  about  yourself,  Dave.  How  has 
the  world  been  treating  you?" 

"Tom,  I  think  a  kind  Providence  sent  you  to  me,  to-day.  I  can 
unburden  my  heart  to  you  as  I  cannot  to  any  other  living  person.  Tom, 
I'm  scared.  Of  course,  you  don't  know  why  or  what  about.  I'll  tell 
you.  I  was  63  years  of  age  last  month.  I've  been  practising  here  42 
years.  I  am  doing  work  now  for  the  grandchildren  of  some  of  my  first 
patients.  You  know  when  I  graduated,  I  was  considered  the  best  oper- 
ator in  the  class.     I  was  fond  .of  operating  and  proud  of  my  ability.    I 


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PIPTY-PIPTY 


297 


was  also  good  in  what  we  then  called  'mechanicar  dentistry.  It's 
'prosthetic'  now.  When  I  located  here  I  was  well  equipped  to  do  good 
work.  I  was  fully  determined  to  do  nothing  but  good  work  and  I  have 
lived  up  to  that  determination.  I  have  always  given  good,  conscientious 
service.  Every  week  I  see  in  the  mouths  of  some  of  my  old  patients, 
gold  fillings  that  I  put  there  fifteen  and  twenty  years  ago,  and  that  are 
still  in  good  condition.  I  have  given  the  community  the  very  best  that 
was  in  me.    They  know  it,  and  appreciate  it.    The  people  here  in  A — 


"I'm  on  the  down  grade.    I'm  slipping.    My  hair  is  almost  white" 


like  ilie.  They  respect  me.  They  trust  me  and  they  know  they  can 
depend  on  what  I  tell  them.  They  ask  my  advice  about  many  other 
matters  than  dentistry.  I  am  really  a  popular  citizen.  The  voters 
elect  me  to  some  minor  town  office  occasionaUy,  such  as  school  trustee, 
board  of  health,  and  such  like.  I  am  quite  in  demand  as  an  after  dinner 
speaker.  I  don't  know  that  I  have  an  enemy  in  town.  I  sometimes 
wish  I  did  have  some  enemies.  It  would  at  least  show  that  I  had  some 
aggressiveness." 

I  remarked  that  what  he  had  told  me  thus  far  would  seem  to  indicate 
that  he  was  ideally  located.  "It  looks  so,  doesn't  it,  Tom?  I'll  show 
you  some  of  the  other  side.  I'm  on  the  down  grade.  I'm  slipping.  My 
hair  is  almost  white.    My  eyes  are  failing  me  and  my  hand  is  a  little 


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296  THE  DENTAL  DIGEST 

unsteady.  They  caU  me  'Old  Dr.  Brown.'  And  the  other  day  I  over- 
heard one  lady  remark  to  another.  'Don't  you  think  Dr.  Brown  is 
failing?'  I  am  failing.  I  am  growing  old.  When  I  think  of  the  future 
I  am  frightened.  I  know  what  you  are  thinking.  You  think  I  had  a 
good  practice  for  all  these  years  and  that  I  have  saved  some  every  year 
and  that  it  is  time  for  me  to  retire  from  practice  and  spend  the  rest  of 
my  life  in  ease  and  comfort.  That  is  as  it  should  be.  Every  dentist 
should  be  able  to  retire  at  60.  I  know  it  now.  I  didn't  forty  years 
ago,  and  the  knowledge  only  recently  came  to  me  and  it  has  come  too 
late.  When  I  located  here  the  conditions  were  unusually  favorable, 
and  I  had  a  good  practice  from  the  very  start  It  increased  until  it 
was  as  good  as  any  practice  in  the  coimtry.  Naturally,  I  was  pleased 
at  my  success.  I  married  and  raised  a  family.  We  lived  as  well  as 
any  family  of  moderate  means  in  the  town.  I  was  very  well  satisfied 
with  myself.  My  ambition  died  an  unnatural  death.  As  my  children 
grew  older  and  my  expenses  increased,  my  income  did  not.  My  practice 
stood  still.  It  was  at  flood  tide,  soon  to  ebb.  Sometimes  the  thought 
came  to  me  that  my  income  from  it  was  not  as  large  as  it  should  be, 
considering  the  amount  of  work  I  did.  I  know  now  why  I  didn't  get 
more  money  out  of  my  practice.  I  was  careless  in  charging  and  care- 
less in  coUecting.  Do  you  remember  how  Professor  B —  used  to  solemnly 
warn  us  students  against  'commercializing  the  profession.'  It  was  a 
nice,  mouth-filling  expression,  and  I  really  thought  it  was  valuable 
advice.  I  tried  to  foUow  it,  and  because  I  followed  it  I  am  a  poor  man 
to-day.  I  have  lost  thousands  of  dollars  through  failure  to  charge  a 
proper  fee,  and  sometimes  because  I  failed  to  charge  at  all.  I  have  lost 
other  thousands  through  loose  methods  of  collection.  I  was  afraid  to 
offend  people  by  sending  them  bills  too  promptly.  I  sent  bills  once  in 
six  months — ^many  times  once  a  year.  People  died,  moved  away,  went 
into  bankruptcy,  and  I  lost.  If  I  had  been  in  the  habit  of  sending 
biUs  once  in  60  days,  or  certainly  every  quarter,  I  should  have  collected 
most  of  this  money." 

"But,  Dave,"  I  interrupted:  "Why  did  you  allow  yourself  to  drift 
along  in  this  manner  so  long?  When  you  first  saw  your  practice  decreas- 
ing, why  didn't  you  find  out  the  reason,  and  get  a  little  system  started 
to  stop  any  further  loss?" 

"It  was  that  same  fallacy  about  'Commercializing  the  profession.' 
I  thought  it  would  not  be  dignified  or  professional.  And  I  really  did 
not  know  just  what  to  do.  I  have  got  most  of  my  ideas  about  'Business 
in  Dentistry'  from  my  most  dangerous  competitor.  He  located  here 
about  two  years  ago.  He  was  right  out  of  college,  just  as  I  was  when 
I  came  here.    He  is  a  first-class  workman,  a  nice  fellow,  dignified,  but 


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PIPTY-PIPTY 


299 


always  pleasant  We  are  very  good  friends,  and  always  have  been.  He 
has  secured  a  good  many  of  my  old  patients,  but  I  know  in  almost  every 
case  he  has  advised  them  to  remain  with  me,  and  has  only  taken  them 
because  they  had  lost  confidence  in  me  on  account  of  my  growing  old, 
and  would  have  gone  elsewhere  if  he  did  not  take  them.  He  always 
speaks  highly  of  me  and  of  my  work.  I  drop  into  his  office  quite  often 
and  he  comes  to  mine,  and  we  have  compared  methods  and  systems. 
He  has  some  advanced  ideas  about  business  in  dentistry,  and  says  mine 
are  all  wrong.  He  has  the  most  complete  and  accurate  system  of  charg- 
ing.   Every  operation  is  charged  on  the  basis  of  the  time  taken  and  the 


'V^  'I     .'i/Jti^t  fif-^l^ 


"I'm  starting  in  on  the  theory  that  dentistry  should  be  on  a  50-50  basis — fifty  professional, 

and  fifty  business" 

material  used.  He  sends  bills  the  first  of  every  month,  and  expects  to 
have  them  paid  promptly.  Think  of  that!  If  I  should  do  such  a  thing 
my  old  patients  would  think  I  had  lost  my  mind.  I  told  him  so,  and 
sprung  that  warning  about  'Commercializing  the  profession.'  'That's 
nine  tenths  bunk,'  said  he.  'I  have  as  much  regard  for  my  profession 
as  any  man,  and  I  wouldn't  do  anything  to  disgrace  it,  but  I  am  not  in 
dentistry  strictly  for  my  health.  It's  my  business,  and  it  must  give  me 
a  living.  I  give  my  patients  good  work,  the  best  service  in  my  power  to 
give.  I  charge  them  a  reasonable  fee  for  this  service,  and  I  expect  them 
to  pay,  and  pay  promptly.  Why  not?  My  butcher,  and  my  grocery- 
man,  and  my  plumber  expect  their  bills  paid  promptly  the  first  of  every 
month.    Why  shouldn't  mine  be  paid  as  often  and  as  promptly?    You're 


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300  THE  DENTAL  DIGEST 

all  wrong,  Dr.  Brown.  You  started  wrong  and  I  suppose  it  is  too  late 
for  you  to  make  a  radical  change.  I'm  starting  in  on  the  theory  that 
dentistry  should  be  on  a  '50-50'  basis — fifty  professional  and  fifty  busi- 
ness. It  must  not  only  give  me  a  living  for  the  present,  but  enable  me 
to  put  aside  something  for  the  future.  If  it  won't  do  that,  I'll  quit  and 
take  up  something  that  will.'  That  was  a  presentation  of  dentistry 
from  a  new  point  of  view,  and  most  especially  the  '50-50'  idea.  It's  the 
right  point  of  view,  but  it  has  come  to  me  too  late.  Don't  you  see  that 
it  has,  Tom?" 

I  was  puzzled  to  know  what  to  say,  what  advice  to  give,  but  sug- 
gested that  there  must  be  some  way  out. 

"If  there  is,  I  have  failed  to  discover  it,  and  I  have  racked  my  brains 
to  find  one,"  said  Dave.  "It's  useless  to  raise  my  prices  after  all  these 
years.  I'd  be  afraid  to  do  it.  I've  got  to  keep  up  my  present  mode  of 
living.  Any  visible  attempts  at  economy  would  be  business  suicide. 
Rats  desert  a  sinking  ship,  you  know.  I  own  a  house  but  it  is  only  p)artly 
paid  for.  I  could  get  along  with  a  smaller,  cheaper  one,  but  there  you 
are  again  confessing  failure.  I  dare  not  risk  it.  I  know  my  friends 
think  I  am  prosperous.  They  think  I  don't  care  to  have  very  much 
practice;  that  I  am  pretty  nearly  ready  to  retire.  I  ought  to  be,  but 
I  can't,  Tom,  I  can't.  Can't  you  understand  why  I  said  I  was  'scared'. 
It  is  pretty  nearly  a  tragedy.  Why  didn't  somebody  tell  me  about 
that  '50-50'  idea  forty  years  ago?  It  would  have  made  just  the  difference 
between  prosperity  and  failure." 

I  had  to  leave  Dave,  but  I  have  had  a  heavy  heart  whenever  I  have 
thought  of  him  and  his  future.  I  wonder  if  there  are  not  many  others 
whose  future  looks  as  dark  as  his,  all  because  they  were  not  taught  that 
dentistry  was  a  business  as  well  as  a  profession? 


THE  NECESSITY  FOR  KEEPING  COMPLETE  RECORDS 

By  C.  Charles  Clark,  D.D.S.,  Kansas  City,  Mo. 

One  of  the  most  difficult  things  for  the  ordinary  professional  man 
to  do,  is  to  get  his  debit  and  credit  records  in  any  sort  of  shape,  and 
some  have  not  the  necessary  help  to  do  this  many  times  unpleasant  work. 
When  one  gets  through  with  a  difficult  operation,  it  is  easy  to  allow  the 
making  of  a  record  to  go  over  until  the  next  day,  so  any  innovation  looking 
toward  simplifying  the  method  of  keeping  these  records  will  be  appre- 
ciated. 

There  are  several  reasons  why  you  should  keep  your  records  so  that 


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THE  NECESSITY  FOR  KEEPING  COMPLETE  RECORDS  301 

they  can  be  understood,  not  only  by  you,  but  by  others,  in  case  there 
arises  a  dispute  as  to  what  was  done  and  what  was  not  done  by  you. 

For  instance,  it  had  always  been  the  habit  of  the  writer,  until  he 
learned  better,  to  arbitrate  his  accounts,  on  any  pretext  whatever  made 
by  the  patient,  but  he  found  he  made  no  friends  by  that  course  of  proce- 
dure, but  on  the  contrary  people  considered  him  easy,  so  he  sought  a 
better  way,  and  found  that  there  were  a  number  of  systems,  the  most 
common,  being  one  with  pictures  of  teeth.  It  is  true  that  you  can 
mark  black  spots  on  the  teeth,  but  that  is  in  addition  to  the  written 
record  of  the  charges,  and  serves  no  additional  purpose. 

The  record  should  be  so  written  that  when  read,  it  forms  a  picture 
in  the  mind  of  the  patient  at  once,  without  further  explanation.  The 
teeth  pictures  occupy  a  great  deal  of  space,  which  could  be  used  to 
better  advantage. 

Did  it  ever  occur  to  you  that  in  other  dignified  callings,  they  do 
not  use  characters  to  represent  the  sales?  However,  they  may  have 
some  particular  code,  which  is  used  as  a  simplification  of  their  written 
record,  which  can  be  explained  so  that  when  a  disputed  account  is 
brought  into  court,  there  can  be  no  question  of  its  meaning. 

The  writer  has  noted  three  kinds  of  accounts,  cash,  book  and  notes. 
Cash  is  the  ideal  business,  and  one  that  exists  in  a  very  few  cases;  open 
accoimts,  the  delusion  and  snare  that  has  caused  many  a  professional 
man  to  end  his  days  in  penury  and  want;  and  the  negotiable  note,  or 
contract,  which  will  permit  you  to  raise  money  before  its  maturity,  if  you 
desire. 

When  it  comes  to  collection  of  your  outstanding  indebtedness,  a 
third  party  can  do  better  for  you  as  a  usual  thing,  and  the  reason  for 
this  is  that  they  have  a  range  of  emotions  to  play  on  that  you  can't  even 
mention,  and  they  seldom  hesitate  to  use  everything  at  their  command 
to  turn  the  debits  into  cash. 

And  I  want  to  repeat  that  you  should  have  an  understanding  with 
your  patient  at  the  earliest  possible  moment  regarding  your  fees.  At 
that  time  he  is  seeking  your  services,  so  then  is  the  most  opportune 
moment  to  arrange  for  future  payment. 

When  your  patient  asks  you  what  your  work  will  come  to,  make  him 
an  estimate,  computed  on  whatever  system  you  may  use;  most  of  us 
have  a  hit  or  miss  system;  we  claim  to  charge  so  much  per  hour,  or  per- 
haps so  much  a  tooth,  but  I  find  that  some  work  I  am  doing  at  less  than 
five  dollars  per  hour,  and  other  work  at  as  high  as  twenty-five  dollars  per 
hour,  so  I  am  trying  to  see  where  I  can  mend  this. 

It  IS  a  fact  that  for  some  classes  of  work  the  patient  will  pay  more  than 
for  others,  because,  as  between  precious  stones,  more  is  paid  for  the  dia- 


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302  THE  DENTAL  DIOBST 

mond  than  for  the  opal,  so  it  is  between  different  fonns  of  service.  The 
pictures  of  the  values  are  different  in  the  patient's  mind,  and  it  is  hard 
to  change  these  pictures. 

However,  we  should  study  and  strive  by  every  honorable  means  to 
arrive  at  a  correct  system,  so  that  we  may  charge  fairly. 

On  my  ledger,  I  especially  note  the  manner  of  payment,  when,  where 
,  and  how  to  be  made,  and  I  find  it  a  good  plan. 

It  is  well  to  know  what  your  patient  can  pay,  for  obviously  you 
wouldn't  try  to  talk  a  laborer's  child  into  a  thousand  dollar  case  of  ortho- 
dontia, and  yet  you  would  not  hesitate  to  tell  a  prosperous  business 
man  that  he  should  spend  a  thousand  dollars  on  his  child  and  proceed 
to  show  him  why. 

"Yield  unto  Caesar  that  which  is  Caesar's"  but  unto  me  that  which 
is  mine,  is  a  lesson  to  all  of  us.  And  say  what  you  will,  you  and  I  often 
work  for  supposedly  deserving  people  for  less  than  we  should  and  these 
people  could  pay  as  well  as  some  others  of  whom  we  ask  more. 

I  have  heard  it  said  that  a  professional  man's  work  was  worth  in 
proportion  to  what  his  patients  were  able  to  pay.  And  in  a  great 
many  instances  you  will  lose  patients  unless  you  charge  them  well.  A 
fee  that  keeps  you  always  laboring,  and  only  permits  you  to  eke  out  an 
existence,  will  never  permit  you  or  any  of  those  dependent  on  you,  to 
get  the  rubber  tire  habit. 

I  presume  that  there  are  a  great  many  who  have  good  records,  but 
if  you  have  not  you  are  cheating  yourself  and  casting  a  certain  amount  of 
discredit  upon  the  profession  of  which  we  want  you  to  be  an  honorable 
member. 

621  CoiiMERCE  Bldg. 


To  Sav'e  Time  During  the  Use  of  Silicate  Cebients. — ^The  ma- 
jority of  silicate  fillings  are  placed  in  the  upper  teeth  while  the  rubber-dam 
is  in  position.  To  save  time  the  dam  has  been  drawn  down  and  tied  with 
a  ligature  and  then  cut  off.  This  sometimes  strains  the  rubber  so  that 
leakage  occurs,  and  when  finishing  it  is  sometimes  annoying  to  control  the 
loose  margins,  and  there  is  also  danger  of  moistening  the  filling.  As  a 
substitute  for  this  procedure  the  following  has  proved  valuable:  During 
the  hardening  of  the  cement,  turn  up  the  lower  edge  of  the  dam  and  pin  it 
securely  to  the  upper  edge  on  both  sides.  The  patient  can  now  talk, 
expectorate,  etc.,  as  though  the  dam  were  not  in  position,  and  even  other 
work  can  be  done. 

When  finishing  is  in  order,  the  dam  is  turned  down  and  the  work  com- 
fortably proceeded  with.— Otto  E.  Inglis,  Philadelphia,  Pa.,  The  Denial 
Cosmos, 


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SELLING  DENTURE  SERVICE  303 

SELLING  DENTURE  SERVICE 

I.  J.  Dresch,  Toledo,  Ohio 

Although  artificial  dentures  were  the  first  mechanical  restorations 
made  by  dentists,  denture  work  is  to-day  the  most  poorly  paid  branch 
of  dentistry.  Notwithstanding  the  great  advancement  of  the  work 
it  is  not  as  remunerative  to-day  as  it  was  fifty  years  ago.  To  a  majority 
of  dentists  with  a  practice  of  ^{3,000  or  more,  denture  work  is  actually 
unprofitable.  These  statements  may  seem  far  fetched,  even  a  trifle 
pessimistic,  but  they  are  hard,  cold  facts,  which  must  be  squarely  faced 
and  eliminated  before  denture  fees  can  be  placed  on  a  proper  basis. 

In  comparison  with  denture  work,  a  fair  fee  is  received  for  crown 
and  bridge  work,  fillings,  inlays,  etc.  Is  there  any  legitimate  reason 
why  the  other  forms  of  work  should  be  more  profitable  than  denture 
work?  Most  assuredly  there  is  not.  Then  why  do  such  conditions 
exist?  Let  us  take  an  example.  Suppose  you  have  a  case  for  a  cast  gold 
inlay;  you  are  extremely  careful  to  apply  the  most  thorough  and  scientific 
knowledge  in  the  cavity  preparation,  and  in  securing  normal  occlusion. 
When  you  have  set  the  inlay  you  are  paid  for  the  material  used,  general 
expense,  and  your  time  plus — ^your  knowledge.  You  have  been  paid 
for  your  professional  knowledge.  Now  on  the  other  hand  suppose  a 
full  upper  denture  is  to  be  made.  Perhaps  an  ordinary  plaster  impr&sion 
is  taken  with  the  mouth  open,  then  the  patient  is  instructed  to  close 
the  jaws  on  a  roll  of  wax  for  the  bite.  That  is  as  far  as  the  patient's 
knowledge  of  the  work  goes  and  to  the  patient  the  service  is  as  mechanical 
as  the  Bertillon  system  of  recording  thumb  prints;  and  the  patient  pays 
for  the  service  as  such.  To  place  denture  work  on  a  financial  parity  with 
other  branches  of  dentistry  it  is  necessary  for  the  dentist  to  be  paid  for 
material,  general  expense  and  time  plus  knowledge.  In  other  words 
denture  work  must  be  placed  on  a  professional  basis  before  the  dentist 
can  expect  professional  fees. 

Here  is  how  three  dentists  of  a  city  in  the  middle  West  placed  their 
fees  for  denture  work  on  a  professional  basis.  In  the  same  city  there 
are  more  than  one  hundred  dentists.  The  average  fee  for  a  denture  is 
$12  and  for  an  upper  and  lower  $20.  Twenty  of  the  most  progressive 
dentists  were  asked  if  they  endeavored  to  sell  anatomical  articulation 
to  the  patient?  If  they  had  become  acquainted  with  the  closed  mouth 
method  of  impression  taking  and  if  they  explained  the  beauty  of  Truby te 
teeth  to  the  patient?  The  astounding  result  was  that  seventeen  out 
of  the  twenty  answered  all  three  questions  in  the  negative.  When 
asked  why  they  made  no  effort  to  sell  such  service  the  answers  were  varied. 


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304  THB  DENTAL  DIGEST 

One  said,  ''What  is  the  use?  It  goes  over  the  patient's  head"  another 
"I  do  not  have  time."  But  all  agreed  that  as  a  general  rule  they  never 
thought  of  trying  to  sell  anything  better.  The  three  dentists  who 
answered  the  questions  in  the  affirmative  said  they  always  explained  the 
merits  of  articulation,  scientific  impressions  and  Trubyte  teeth.  That 
they  had  no  trouble  in  persuading  eighty  per  cent,  of  the  patients 
to  accept  the  better  service.  One  said  he  did  not  think  it  would  be  fair 
to  the  patient  to  go  ahead  with  the  ordinary  work  and  not  explain  the 
better  things.  These  three  dentists  average  $50  for  an  upper  and  lower. 
They  said  they  often  received  $60  but  the  fee  would  be  somewhat  re- 
duced for  some  of  their  old  patients,  and  those  not  financially  able  to 
pay  well. 

One  was  asked  how  he  presented  his  selling  talk  to  the  patient. 
His  answer  ought  to  mean  increased  fees  for  many  dentists.  "First  of 
all  I  explain  the  difference  between  an  impression  taken  with  the  mouth 
open,  and  one  that  is  taken  with  the  mouth  closed.  The  average  patient 
is  interested  in  how  the  work  will  be  done  so  I  take  time  to  make  aU 
perfectly  clear  to  the  patient.  Then  I  show  the  difference  between  oc- 
clusion and  articulation.  Two  specimen  cases  are  best  for  that;  one  set 
arranged  the  old  way  and  mounted  on  a  plain  line  articulator,  the  other 
set  anatomically  articulated  and  mounted  on  a  Gysi  Simplex.  These 
specimens  make  it  easy  for  the  patient  to  understand  what  articulation 
means.  Of  course  I  show  the  beauty  and  efficiency  of  Trubyte  teeth, 
the  moulds  and  shadings  as  compared  with  other  teeth,  and  there  are 
very  few  patients  who  do  not  readily  see  their  superiority." 

This  dentist  has  been  in  the  same  location  seventeen  years.  His 
office  is  in  the  residential  district  of  a  middle  class  of  people.  He  has 
increased  his  denture  fees  one  hundred  per  cent,  in  the  last  five  years, 
and  he  is  not  what  could  be  called  a  good  salesman;  just  a  good  con- 
scientious dentist  who  has  been  rendering  service.  He  has  found  that 
people  in  moderate  circumstances  will  i>ay  for  service;  and  he  has  placed 
his  dentiu-e  work  on  a  professional  basis  and  is  being  paid  professional 
fees.  He  is  being  paid  for  material^  general  expense  and  time,  plus — 
put  the  plus — ^in  your  denture  fee. 

360  Spitzer  Bldg. 


Bad  teeth  and  ill-kept  gums  not  only  look  bad,  and  feel  uncomfort- 
able if  not  painful,  but  they  let  in  more  serious  disease  like  rheumatism, 
chronic  sepsis,  and  tuberculosis.     It  doesn't  pay  to  "let  the  teeth  go." 

—The  Healthy  Home. 


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THE  SUCCESSFXTL  PRACTICE  OF  DENTISTRY  30S 

THE  SUCCESSFUL  PRACTICE  OF  DENTISTRY* 

By  Wallace  Seccombe,  D.D.S.,  Professor  Preventive  Dentistry 

AND  Dental  Economics,  Royal  College  of  Dental 

Surgeons,  Toronto 

This  excellent  article  is  worthy  of  careful  reading  by  every  dentist  who 
desires  to  combine  good  professional  and  good  business  methods. — 
Editor. 

There  was  never  a  time  when  more  exacting  demands  were  made 
upon  the  dental  surgeon  than  the  present.  Changes  in  the  science  and 
practice  of  dentistry  are  so  rapid  that  a  practitioner  may  become  old- 
fashioned  in  j&ve  years.  Fifteen  years  ago  the  younger  members  of 
the  profession  were  universally  considered  more  modern  in  their  prac- 
tice than  were  the  older  graduates.  That  time  has  passed.  Advances 
have  been  so  rapid  that  it  is  not  now  a  question  of  being  old  or  young, 
but  whether  you  are  abreast  of  the  times.  The  advantage  has  gradually 
passed  from  the  younger  graduate  to  the  older  man,  who  is  familiar 
with  the  best  thought  of  the  profession  and  is  able  to  bring  his  wider 
experience  to  bear  upon  modem  methods  of  practice. 

The  standard  of  dental  service  is  being  continually  raised.  The 
dental  graduate  who  leaves  college  to-day  with  the  impression  that 
he  can  settle  down  comfortably  to  the  practice  of  dentistry,  dispose 
of  his  college  texts,  ignore  dental  magazines  and  dental  meetings,  stamps 
himself,  at  the  very  outset,  as  a  complete  failure.  Likewise,  the  older 
practitioner  who  has  failed  to  study  the  later  dental  works  and  has  thought 
himself  too  busy  to  attend  dental  conventions  is  also  a  failure.  He 
does  not  render  that  high  quality  of  service  which  his  years  of  experi- 
ence would  otherwise  make  possible. 

Heretofore,  there  have  been  those  who  have  argued  that  the  prac- 
tice of  dentistry  would  never  assume  the  importance  of  that  of  medi- 
cine, because  in  the  one  case  a  tooth  was  at  stake  and  in  the  other  a 
life.  The  logic  of  that  argument  has  been  destroyed  through  the  dis- 
coveries of  science,  that  the  presence  of  rheumatism,  neuritis,  endo- 
carditis, gastric  ulcer,  nephritis,  and  other  systemic  lesions  are  due,  in 
many  cases,  to  local  foci  of  infection  about  the  roots  of  teeth.  Rose- 
now  has  established  conclusively  the  facts  concerning  the  transmuta- 
tion of  streptococci,  the  organism  having,  in  one  instance,  an  affinity 
for  the  joints;  in  another,  for  the  appendix,  or  in  still  another  for  the 
stomach. 

•Read  before  London  Dental  Society,  24th  February,  191 6. 
Read  before  Toronto  Dental  Society,  13th  March,  19 16. 
Read  before  Hamilton  Dental  Society,  15th  March,  10 16. 


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306  THB  DBRTAL  DIGEST 

For  many  years  the  dental  profession  has  recognized  the  relation- 
ship between  septic  conditions  in  the  oral  cavity  and  many  systemic 
diseases,  but  that  knowledge  has  been  based  largely  upon  clinical  experi- 
ence. Through  the  observations  of  Hunter  and  Osier,  and  the  ex- 
periments of  Rosenow,  Billings,  Gilmer  and  others,  the  direct  rela- 
tionship between  local  foci  of  infection  in  the  oral  cavity  and  systemic 
conditions  of  disease  has  been  scientifically  shown.  The  result  is  that 
leading  members  of  the  medical  profession  have  come  to  regard  den- 
tistry as  a  most  important  factor  in  preventive  medicine. 

Now  what  does  all  this  mean?  It  means  that  the  practice  of  den- 
tistry is  a  matter  not  of  saving  the  teeth  alone,  but  of  preserving  life 
and  health.  It  means  that  much  of  the  present  practice  of  dentistry 
will  be  revolutionized.  As  a  profession  we  shall  have  to  adopt  an  en- 
tirely different  attitude  toward  the  question  of  the  vitality  of  the  teeth 
and  the  treatment  of  those  roots  that  are  comfortable  and  apparently 
healthy,  and  yet  are  maintaining  a  source  of  systemic  infection.  It 
means  that  the  public  will  appreciate  the  importance  of  aseptic  root 
canal  work,  and  will,  because  of  the  vital  issues  at  stake,  demand  that 
dental  service  be  rendered  in  conformity  with  the  most  advanced  me- 
thods of  practice,  and  be  more  willing  to  pay  adequately  for  that  service. 

Now  let  us  turn  for  a  moment  and  ask  ourselves  the  question:  What 
is  the  successful  practice  of  dentistry?  The  successful  practice  of 
dentistry  might  be  defined  thus,  the  rendering  of  the  best  possible 
service,  under  the  most  agreeable  conditions,  and  the  acquirement  of 
fair  remuneration  for  the  service  so  rendered. 

When  we  speak  of  "rendering  the  best  possible  service"  we  are 
dealing  with  a  variable  factor.  The  service  rendered  by  one  dentist 
may  be  a  very  diflferent  service  to  that  rendered  by  another,  though 
in  each  case  the  service  may  have  been  *'  the  best  possible."  It  is  like- 
wise true  that  circumstances  may  compel,  in  dififerent  patients,  diflFerent 
treatment  of  similar  conditions,  and  though  the  operator  be  the  same, 
and  though  he  may  render  the  best  possible  service  under  the  circum- 
stances, the  service  rendered  in  each  case  may  vary. 

Rendering  service  is,  after  all,  the  most  important  factor  in  suc- 
cessful practice.  Unfortunately,  skill  and  success  are  by  no  means 
synonymous,  though  a  distinct  relationship  exists  between  them.  Bet- 
ter dentistry  makes  for  success,  and  success  encourages  better  dentistry. 

There  are  many  dentists,  skilled  in  the  science  of  dentistry,  who 
fail  entirely  in  the  successful  conduct  of  a  dental  practice.  Upon  the 
other  hand  there  are  those  possessing  only  average  skiU,  who  apply 
correct  principles  in  the  management  and  control  of  practice,  and  who, 
therefore,  meet  with  a  fair  measure  of  success.    Every  member  oi  the 


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THE  SUCCESSFXTL  PRACTICE  OF  DENTISTRY  307 

profession  should  aim  to  be,  not  only  a  skilful